Notifications by PDMPs May Not Effectively Reduce Opioid Misuse

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Patients who obtained monitored substances from ≥4 prescribers and ≥4 state pharmacies in the previous 6 months were thought as likely to misuse controlled substances.
Patients who obtained monitored substances from ≥4 prescribers and ≥4 state pharmacies in the previous 6 months were thought as likely to misuse controlled substances.

Unsolicited notices to prescribers as part of prescription drug monitoring programs (PDMPs) may not effectively reduce opioid use, as patients may seek other prescribers, according to a study published in Pain Medicine.

Patients who were likely to misuse controlled substances including opioids (ie, obtained monitored substances from ≥4 prescribers and ≥4 state pharmacies in the previous 6 months) were identified using PDMPs prescription databases between August 2012 and October 2013, were assigned to an intervention group in which prescribers were notified of a patient's history of controlled substance prescriptions (n=436) or a no-notification group (n=441).

Within one week, letters were sent to all prescribers and pharmacies detailing the participants' methods of obtaining controlled substances, including the names and addresses of prescribers and pharmacies that patients had used over the last 6 months. The letters encouraged prescribers to discuss the issue with their patients. In the no-notification group, no letters were sent. Neither patients, nor prescribers or pharmacies were notified that they were part of a research study.

Eighty-four percent of the notified prescribers discontinued prescribing after notification compared with 80.5% of prescribers who had not been notified. Replacement prescribers were found by 51.4% of patients in the notification group vs 47.1% in the control group.

“Even though we found a small positive effect of notification on prescribers, patients' skill in finding new prescribers swamped the positive effects of notification,” noted the study authors. “[I]f the logistical, policy, and legal issues surrounding mandatory checks [of PDMPs] can be resolved, this practice is likely to be the best use of PDMPs, and more effective than time-consuming unsolicited notification, in preventing prescription drug misuse,” they concluded.

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Reference

McDonald DC, Carlson KE, Jalbert SK. An experimental test of the effectiveness of unsolicited reporting by a prescription drug monitoring program in reducing inappropriate acquisition of opioids [published June 1, 2018]. Pain Medicine. doi: /10.1093/pm/pny095

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