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Prescription Monitoring Programs Curb Opioid Prescribing

Prescription Monitoring Programs Curb Opioid Prescribing
Nicola M. Parry, DVM
June 06, 2016

Implementation of prescription drug monitoring programs is associated with a substantial reduction in physicians’ prescribing of Schedule II opioids during an office visit for pain, a new study suggests.

Yuhua Bao, PhD, from Weill Cornell Medical College, New York, New York, and colleagues used National Ambulatory Medical Care Survey (NAMCS) data to investigate the effects of recent launching of these programs on the prescribing of opioids and other pain medications. The researchers published the results of their study online June 6 in Health Affairs.

“Our analysis of the NAMCS data suggests that the recent wave of implementations of prescription drug monitoring programs was associated with a sizable reduction in the prescribing of Schedule II opioids — the subset of prescription opioids deemed to be at the highest risk of misuse and abuse — while having limited effects on the prescribing of opioid analgesics of any kind and of other pain medication,” the authors write.

According to data from the Centers for Disease Control and Prevention, prescription opioid painkillers were responsible for almost 19,000 drug overdose deaths in the United States in 2014.

Prescription drug monitoring programs are state­-run electronic databases that collect and track the prescribing and dispensing of controlled substances to patients. Following a recent wave of implementation of prescription drug monitoring programs, all states except Missouri have now created these programs, according to the authors.

Effective monitoring of the prescribing and dispensing of prescription drugs can help providers to identify and prevent problems such as “doctor shopping” or drug diversion. However, studies to date have reported conflicting results about the extent to which these programs have actually changed opioid prescribing.

Dr Bao and colleagues therefore evaluated the effects of recent state implementation of monitoring programs on the prescribing of opioids and other pain medications to manage pain in ambulatory care settings. They analyzed data from the NAMCS that covered the use of these programs in 24 states from 2001 through 2010. The data sample comprised 26,275 visits by patients aged 18 years and older who visited an office­-based physician because of pain.

Five percent of these visits resulted in the prescription of at least one Schedule II opioid, 15% in at least one opioid of any kind, 41% in any pain medication, and 24% in at least one nonopioid medication.

In addition to finding a reduction in Schedule II opioid prescriptions, the researchers showed a slightly increase in the prescribing of nonopioid medication.

However, according to the authors, “the only significant effect was on Schedule II opioid prescribing.” The rate of prescribing Schedule II opioids decreased by more than 30% after implementation of prescription drug monitoring programs. The probability of a physician prescribing Schedule II opioids during an office visit for pain dropped from 5.5% to 3.7%.

The results also show that the effect of implementation of such programs on the prescribing of Schedule II opioids and all opioids was both immediate and maintained in the second and third years thereafter. Specifically, prescribing of Schedule II opioids dropped 2.1 percentage points during the first 6 months after implementation, 2.2 percentage points during months 7 to 12, and 1.8 percentage points during months 19 to 24; at subsequent time points, the effect was smaller and not significant.

Moreover, prescribing of all opioids was significantly reduced by 2.2 percentage points during the first 6 months after implementation, but reductions at subsequent time points were not significant. Prescribing of any pain medication was also significantly reduced by 4.3 percentage points when a program was in its third year or later.

Dr Bao and colleagues emphasize that these results are encouraging because they suggest that providers are changing their analgesic prescribing practices and reducing their reliance on opioids in favor of alternative options.

However, they conclude that “future research is needed to evaluate the comparative effectiveness of key policies and practices designed to promote the reach and effectiveness of these programs.”

This study was funded by the Center for Health Economics of Treatment Interventions for Substance Use Disorder, HCV, and HIV (CHERISH), as well as the Translational Institute on Pain in Later Life at Cornell and Columbia Universities. Dr Bao received support from the National Institute of Mental Health; Dr Schackman received support from the National Institute on Drug Abuse; and Dr Pincus received support from the Commonwealth Fund and the National Center for Advancing Translational Sciences, National Institutes of Health.