Rockville, Md. – Prescription Drug Monitoring Programs (PDMPs) are state-based tools designed to inform prescribers about their patients’ purchases of controlled prescription drugs, including opioids, which have led to tens of thousands of overdose deaths each year. In nearly all states, PDMPs offer physicians the ability to see if others have been prescribing opioids or other controlled drugs to their patients, but prescribers typically need to initiate these inquiries.
Alternatively, PDMPs can mine the data proactively to flag patients who use multiple prescribers and pharmacies to acquire suspiciously large amounts of opioids and then send an alert to notify the prescribers and pharmacies used by these patients. The hope is that these providers will act to limit patients’ inappropriate and risky use of opioids.
A study by Abt Associates published in Pain Medicine offers new evidence that the promise of proactive notifications from PDMPs has yet to be realized.
Nevada’s PDMP staff searched its database to identify patients who had received prescriptions for opioids from five or more different prescribers and had them filled by five or more different pharmacies during the past six months. These patients were then assigned at random to two groups. Prescribers and pharmacies used by patients in one group were sent unsolicited letters that listed the names and contact information of all other prescribers and pharmacies these patients had used during the last six months to obtain opioids and other controlled drugs. These letters encouraged providers to discuss concerns with their patients, as appropriate. Providers of control patients were not notified. The study’s authors then examined opioid prescriptions obtained by patients in both groups during the following months.
Key Findings include:
Health Care Providers Stopped Prescribing. During the six months after the assignment, 84 percent of patients in the notification group did not receive additional opioid prescriptions from the prescribers they had previously used. But this was only slightly more than the percentage of patients in the other group (80.5 percent). Proactive notification therefore had only a small—but statistically significant, effect on continued use of providers.
Patients Found Other Prescribers. Patients who stopped getting prescriptions from their original prescribers obtained prescriptions from new prescribers who had not been notified. This pattern was found in both groups and cannot be attributed to notification. The net result was that proactive notification had only a minimal effect on the total number of opioid prescriptions dispensed, the amounts of opioids dispensed, and the numbers of distinct prescribers and pharmacies used.
Proactive Notification Is Not Cost Effective. PDMP staff spent an average of an hour and a half per patient to notify his or her providers. Given the small effect on patients’ acquisition of opioids, the study’s authors suggest that data mining and proactive notification is not a productive use of resources.
“Requiring prescribers to check their patients’ recent history of purchasing controlled drugs in the state’s PDMP is likely to be a more effective strategy for curbing doctor shopping and uncoordinated care,” said Douglas McDonald, Ph.D., Abt principal associate and lead investigator of the study. “We understand that many clinicians are hard pressed for time when they see their patients, especially in primary care settings. States therefore need to develop ways to make information on opioid prescribing quickly available so that clinicians can manage their patients’ use of opioids as safely as possible.”
The article was supported with funding from the National Center for Injury Prevention and Control, Centers for Disease Control and Prevention.
About Abt Associates
Abt Associates is an engine for social impact, dedicated to moving people from vulnerability to security. Harnessing the power of data and our experts’ grounded insights, we provide research, consulting and technical services globally in the areas of health, environmental and social policy, technology and international development. http://www.abtassociates.com