Prescription Drug Monitoring Programs: How Effective Are They?

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Contrary to the investigators' hypothesis, clinicians who registered to prescription drug monitoring programs did not demonstrate faster declines in high-risk opioid prescribing.
Contrary to the investigators' hypothesis, clinicians who registered to prescription drug monitoring programs did not demonstrate faster declines in high-risk opioid prescribing.

Although registration in prescription drug monitoring programs (PDMPs) was shown to lead to statewide declines in high-risk opioid prescriptions, these declines were similar to those observed in non-PDMP registrants, according to a study published in the Journal of Pain.

Investigators of this retrospective study analyzed PDMP data across the state of Oregon to determine whether PDMP implementation had an effect on opioid prescribing and associated hospitalization and mortality rates. In this study, researchers matched early PDMP registrants (n=927) with nonregistrant prescribers.

After incorporation of PDMPs in statewide prescription programs, the investigators observed per capita decreases in opioid prescriptions throughout the state of Oregon. Clinicians who frequently used PDMPs wrote fewer prescriptions for high-risk opioid medications at baseline compared with infrequent PDMP users. Although this association was observed at follow-up, registrants of PDMPs did not write significantly fewer high-dose opioid prescriptions than nonregistrant participants.

Contrary to the investigators' hypothesis, clinicians who registered to PDMPs did not demonstrate faster declines in high-risk opioid prescribing compared with nonregistered clinicians. In addition, the implementation of PDMPs did not result in significant changes in opioid-related hospitalizations or mortality.

In this study, the researchers had no available data on patient diagnoses, and were unable to account for prescribing physicians who had left the state or ceased medical practice after joining the study, thus potentially limiting the findings.

The investigators suggest that some of the decline in statewide "opioid prescribing may have resulted from an 'observer effect', in which clinicians perceived that prescribing patterns were being more closely scrutinized."

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Reference

Deyo RA, Hallvik SE, Hildebran C, et al. Association of prescription drug monitoring program use with opioid prescribing and health outcomes: a comparison of program users and non-users [published online October 17, 2017]. J Pain. doi: 10.1016/j.jpain.2017.10.001

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