On July 14 Sen. Joe Manchin (D-WV), along with Sens. Amy Klobuchar (D-MN) and Angus King (I-ME), introduced the Prescription Drug Monitoring Act, to require all states that receive certain federal funding to make their program data available to other states. The bill was introduced just after the Senate passed the Comprehensive Addiction and Recovery Act (CARA), to help combat the opioid epidemic nationwide.
The dramatic rise in sales of opioid pain relievers over the past two decades, along with the accompanying surge in opioid-related overdose deaths, prompted 49 states to establish prescription drug monitoring programs (PDMPs) to track high-risk behaviors of patients and prescribers. By 2014, all states except Missouri had PDMPs in place.
Physicians—87 percent of them—are on record as supporting PDMPs, according to a national survey by the American Medical Association (AMA). Those surveyed agreed that the programs help physicians become more informed about a patient’s prescription history.
Study on the Effectiveness of PDMPs
The retrospective study summarized below, “Implementation of Prescription Drug Monitoring Programs Associated With Reductions in Opioid-Related Death Rates,” assesses the effectiveness of PDMPs. The study was recently published online and in Health Affairs.
Study Details
Objective
- Determine if PDMPs—or if particular characteristics of PDMPs—reduce deaths associated with accidental or intentional overdoses of opioids
Study Methods
- Used PDMPs to collect and analyze pharmacy data on controlled substances
- Analyzed publicly available data on monitoring and mortality for 49 states, 1999 to 2013
- Adjusted the data for factors—such as unemployment and limited education—that could influence someone’s risk of overdose death
- Reported the data on controlled substances to the people who prescribe them
Outcome of Interest
- Opioid-related overdose deaths each year per 100,000 residents, by state
Results
How the programs were structured—including such factors as the number of drug schedules monitored, and the requirements set up for the physicians and pharmacies using the program, varied greatly among the states.
For the 34 states that implemented programs during the study period, the average opioid-related death rate per 100,000 rose from 1.4 in 1999 to 6.2 in 2013. But the results varied markedly among the states, with seven states tallying opioid-related death rates of 10 or more per 100,000, and seven others reporting death rates of less than three per 100,000.
Ultimately it was the implementation of a program that lowered opioid-related deaths, not specific characteristics of the programs.
- On average, establishing a PDMP reduced opioid-related overdose deaths by 1.12 per 100,000 people the following year
- States with the strongest PDMPs (programs that monitored the greatest number of drugs that had abuse potential, and updated their data at least weekly) had the greatest reductions in deaths
If Missouri, the lone hold-up (and still without a program) had adopted a PDMP, and if other states had strengthened their programs, another 600 opioid-overdose deaths could have been prevented this year.
Authors’ Suggestions
The authors identified several areas that merit looking into. Among them: require prescribers to register with a program, and to actually use it; and enable neighboring states to access each other’s programs. Money is a key issue. Funding for the programs “is frequently inconsistent and at risk, which jeopardizes their ability to remain operational,” the authors said. They added that their findings support bolstering PDMPs and “establishing a consistent and predictable funding source for them.”
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Patrick SW, Fry CE, Jones TF, Buntin MB. Implementation of prescription drug monitoring programs associated with reductions in opioid-related death rates [Epub ahead of print June 22, 2016]. Health Affairs. 35:7, 2016. doi: 10.1377/hlthaff.2015.1496. Available at http://content.healthaffairs.org/content/early/2016/06/16/hlthaff.2015.1496.abstract. Accessed August 11, 2016
Manchin Introduces Legislation to Require Use of Prescription Drug Monitoring Programs. July 14, 2016. Available at http://www.manchin.senate.gov/public/index.cfm/press-releases?ID=E3E4F099-4D01-489A-B4FD-75E5ACB63ABB. Accessed August 11, 2016
National Survey Finds Physicians Support PDMPs, Encounter Barriers to Providing Non-opioid Therapy to Treat Patients’ Pain [press release]. Chicago, IL: AMA News Room; February 18, 2016. Available at http://www.ama-assn.org/ama/pub/news/news/2016/2016-02-18-barriers-non-opioid-therapy.page. Accessed August 11, 2016
