Prescription drug monitoring systems reduce rates of prescription of Schedule II opioids by 30 percent

A study, published by Health Affairs, has found that when healthcare systems implement prescription drug monitoring databases, the rate of prescriptions for Schedule II opioids at an office visit for pain dropped by 30 percent.

Deaths due to prescription opioid overdoses topped 19,000 in 2014 with some 10 million Americans reportedly used opioid non-medically in 2014. The question of how to reduce opioid abuse is one growing in importance for the medical industry.

The authors of the Health Affairs study argue one of the answers is the implementation of prescription drug monitoring programs, statewide databases that gather information from pharmacies on dispensed prescriptions of controlled substances.

Evidence is limited about the true extent to how the implementation of these programs has changed opioid prescribing at the point of care. Other studies have linked prescription drug monitoring program implementation in selected states or years with trends in aggregate opioid consumption or population rates of opioid abuse, opioid-related inpatient admissions, and overdose deaths. This study stands to put an end to these differing outcomes.

“In this study we assessed the effects of recent state implementation of prescription drug monitoring programs on the prescribing of opioids and other pain medication to manage pain in ambulatory care settings” said Yuhua Bao, lead author on the study, and co-authors. “We used data from a national survey to assess the effects of these programs on the prescribing of opioid analgesics and other pain medications in ambulatory care settings at the point of care in 24 states from 2001 to 2010, we also assessed whether the effects of implementation became stronger the longer a program had been in effect."

In total, there were 26,275 ambulatory care office visits for pain that took place in those states with a prescription drug monitoring program between 2001 and 2010.

Results found that that implementation of a prescription drug monitoring program lead to a decrease in the prescribing of Schedule II opioids, opioids of any kind and pain medication overall. There was also an increase in the prescribing of non-opioid analgesics.

The most significant effect was on Schedule II opioid prescribing, where the probability of prescribing at an office visit with pain dropped from 5.5 percent to 3.7 percent, which was more than a 30 percent reduction. These results occurred immediately after the launch of providers’ and dispensers’ access to a program database and was sustained in the second and third years afterward.

“We also found that the effect of implementation on the prescribing of Schedule II opioids and all opioids was immediate, and that after the first six months this effect remained strong for Schedule II opioids but was attenuated for opioids of any kind,” said Bao and colleagues.

The study also discusses why only about half of states have implemented these programs. The low take-up of drug monitoring systems could be due to the limited effect of implementation on overall opioid and pain medication prescribing. However, with more and more states adopting such policies and practices, the effects may become more common among prescribers.

“As prescription drug monitoring program policy making has shifted from implementation to enhancement, future research is needed to evaluate the comparative effectiveness of key policies and practices designed to promote the reach and effectiveness of these programs,” wrote Bao and colleagues.