New Study Recommends RX Drug Monitoring Programs Shift To Proactive Approach

Prescription painkillers account for more overdose deaths annually than for heroin and cocaine combined. Yet few states are fully analyzing the data they collect in programs designed to curb substance abuse and addiction.

Researchers, experts from the Prescription Drug Monitoring Program Center for Excellence at Brandeis University’s Heller School for Social Policy and Management, assessed existing prescription drug monitoring programs (PMDPs) across the U.S. and found a veritable “patchwork” of strategies and standards.

The epidemic of prescription drug abuse in America is not only devastating to families, but drains state and federal time, manpower and money.

“Being proactive is the key to success in the fight against prescription painkiller abuse,” said John L. Eadie, Director, PDMP Center of Excellence at the Heller School for Social Policy and Management, Brandeis University. The problem is, as Eadie outlines it, that where doctors might routinely collect and report data to a state program that signals where and when prescription painkillers, for example, are being abused, the state program may not share that information with others who may need it.

Principal investigator of Brandeis’ Center for Excellence, Peter Kreiner, said that state programs should analyze the data they collect and then “reach out to prescribers, pharmacists, insurers, law enforcement agents and others who can prevent powerful narcotics from falling into the wrong hands.”

And where such data analysis and outreach is already being done, Kreiner continued, “It has proven to be very effective.”

The report, “Prescription Drug Monitoring Programs: An Assessment for the Evidence of Best Practices,” is available on the Pew Health Group website (http://www.pewhealth.org/reports-analysis/reports/prescription-drug-monitoring-programs-an-assessment-of-the-evidence-for-best-practices-85899418404/3).

According to the report, by the end of 2001, 16 states had authorized the creation of prescription drug monitoring programs. Eleven years later, that number grew to 49 states and one territory that had passed legislation authorizing PMDPs. Today, 41 states have prescription drug monitoring programs in operation.

Established Value of PMDPs

The report notes at the outset that PMDP data are “unique and irreplaceable in identifying questionable activity with respect to prescription drugs, such as doctor and pharmacy shopping, fraud, and problematic prescribing. No other system exists that can compile all controlled substances prescriptions, regardless of who issued the prescription, which pharmacy dispensed it, or the source of payment.”

The paper addresses the question of which program characteristics and best practices are likely to enable PMDPs to more effectively collect, analyze, disseminate and utilize the data they do collect.

According to the report, by the end of 2001, 16 states had authorized the creation of prescription drug monitoring programs. Eleven years later, that number grew to 49 states and one territory that had passed legislation authorizing PMDPs. Today, 41 states have prescription drug monitoring programs in operation.

Best Practices Identified

The study identified a total of 35 best practices, 21 of which require research studies and documented expert opinion in order to proceed. The 21 represent a list of promising practices identified through anecdotal discussions with experts in the field, but there is no research evidence demonstrating their effectiveness or formal written documentation of expert opinions.

An additional six had documented case studies or expert opinions. These include:

  • Adopting a uniform and latest ASAP reporting standard
  • Collecting data on nonscheduled drugs implicated in abuse
  • Reducing data collection interval time and moving toward real-time data collection
  • Enabling access to data by appropriate users and encouraging innovative applications
  • Enacting and implementing interstate data sharing among PMDPs
  • Collaborating with other agencies and organizations

The researchers found research evidence (excluding case studies) for approximately one-quarter (eight out of 35) of the best practices identified in the paper. These best practices and the findings of the report include:

  • Collecting data on all schedules of controlled substances – States that collected prescribing data for all controlled substances (e.g., anti-anxiety medication, and painkillers) reported lower rates of doctor-shopping (visiting multiple doctors to obtain prescriptions) than other states.
  • Instituting serialized prescription forms – Three states, Texas, Nevada, and California, using serialized prescription forms had lower instances of opioid overdose death rates than states not using state-issued prescription forms.
  • Conducting epidemiological analyses – Analyzing trend data helped law enforcement agencies of states neighboring Georgia identify possible “pill mills” in Georgia that were illicitly distributing prescription painkillers.
  • Providing continuous online access to automated reports – After this change in Virginia, the number of data queries increased and the number of individuals meeting doctor-shopping criteria decreased. There was also increased use by Virginia medical examiners.
  • Sending unsolicited reports and alerts – Proactively sending alerts about possible abuse to physicians and pharmacists was associated with decreased prescription sales; no effect of unsolicited reports on drug overdoses or opioid-related mortality but may reduce supply; in Wyoming, there was reduced doctor shopping after implementing sending unsolicited reports; in Nevada, there were a reduced number of prescribers, dispensers, and dosage units for individuals for whom unsolicited reports were sent.
  • Conducting promotional campaigns – After promotional campaigns in early 2010, the number of registered users and data inquiries increased (Virginia).
  • Improving data timeliness and access – Case studies suggest that enabling access to additional categories of end users increases PMDP utilization.
  • Conducting user education – Provider detailing associated with reduced prescription opioid death rate and improved provider prescribing behaviors; PMDP prescriber educational intervention associated with reduced MEP use.

The research was funded by The Pew Health Group, a division of Pew Charitable Trusts.

What To Expect

While publicizing the results of the research is step one, what can the general public expect in the near term? Progress along these lines, like recovery from addiction itself, takes time, perseverance and attention to detail. As the subject matter experts and co-authors of the report indicated in press materials detailing their findings stated, more research studies and documented expert opinion are required.

The good news is that such activity is likely to be stepped up, given the seriousness of the prescription drug abuse epidemic in America. When best practices can be shown to be effective, i.e., reduced rates of doctor-shopping, lower instances of opioid overdose death rates, their spread will likely continue at a faster pace.

Bottom line: the fight against prescription drug abuse is a multi-layered and long-term effort that requires coordinated, measured, and consistent application of best practices that have been proven to work.

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The Pain of Addiction

Vicodin addiction often starts innocently enough. Most people start taking Vicodin or other pain medications after surgery or an injury. But then they can’t stop. They need more to get the same pain relief. They start doctor shopping to get more pills. And the cycle continues until it takes over their lives.