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 “Our study shows that prescription-drug monitoring programs are a
promising component of a multifaceted strategy to address the opioid
epidemic,” Ryan Mutter, one of the study authors, said in a phone
interview. He is a health economist at the Substance Abuse and
Mental Health Service Administration in Rockville, Maryland.
Mutter and other researchers analyzed annual nationwide surveys of
drug use and health from 2004 until 2014, when 36 states implemented
prescription-drug monitoring programs, or PDMPs.
PDMPs are state-run electronic databases designed to track
prescribing of controlled substances and to identify people at high
risk of using opioids for nonmedical purposes. Every state except
Missouri now has a drug-monitoring program. Some states have
mandatory programs requiring physicians to participate, and other
states have voluntary programs.
The study, reported in the journal Addictive Behaviors, found that
in states where physicians were required to check an electronic
database before writing an opioid prescription, the odds that two or
more doctors would be giving pain relievers for nonmedical purposes
to a single patient were reduced by 80 percent. States that
implemented voluntary monitoring programs showed a 56 percent
reduction in the odds of doctor-shopping.
States with mandatory prescription-drug monitoring programs reduced
the use of painkillers for nonmedical purposes by an average of 20
days a year, the study found. States with voluntary
prescription-drug monitoring program reduced the use of painkillers
for nonmedical purposes by an average of 10 days a year.
“Overall, this, as well as other studies, suggests there’s promise
for prescription-drug monitoring programs,” Dr. Stephen W. Patrick
said in a phone interview. “But they aren’t a panacea.”
“We really need a comprehensive approach. It isn’t one thing that
will help get us out of the opioid epidemic,” said Patrick, a
pediatrician at Vanderbilt University School of Medicine in
Nashville, Tennessee. He treats newborns struggling with the
symptoms of withdrawal from opioids prescribed to their mothers and
was not involved in the new study.
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Every day, 91 Americans die from an opioid overdose, according to
the U.S. Centers for Disease Control and Prevention. Since 1999,
deaths from prescription opioids have quadrupled, as have sales of
opioids, including the painkillers oxycodone (Oxycontin) and
hydrocodone (Vicodin).
The number of PDMPs has expanded rapidly across states since 2000,
but prior studies have shown mixed results about their
effectiveness, the study authors write.
One previous study found that drug-monitoring programs help prevent
10 opioid-overdose deaths a day in the U.S., yet improvements could
save another two people a day. States with the most robust programs
– ones that tracked a greater number of potentially addictive
medications and updated their databases at least weekly – saw the
biggest drops in overdose deaths, the previous study showed.
Public health advocates worry that an unintended consequence of
drug-monitoring programs could be that opioid users would seek drugs
illegally and turn to heroin, the authors write. But the current
study found that PDMPs did not lead to an increase in people
starting to use heroin.
Lead author Mir M. Ali said in a phone interview he found it
“reassuring” that drug-monitoring programs were not responsible for
opioid users substituting heroin. Ali is a health economist at the
Substance Abuse and Mental Health Services Administration.
“In any situation where you’re limiting supply, people might begin
to substitute,” Patrick said. “What we really need to do is focus on
how we get control of the prescription opioid epidemic.”
SOURCE: http://bit.ly/2keeNFn Addictive Behaviors, online January 6,
2017.
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