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 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 research showed.
Implementing drug monitoring in all states and strengthening weaker
programs could prevent another 600 opioid-overdose deaths this year,
researchers calculated.
“Prescription drug-monitoring programs are a public health tool to
ensure that we’re using opioids appropriately but limiting the
negative health impacts we see in almost every community in the
United States,” lead author Dr. Stephen W. Patrick said in a phone
interview.
“Our findings suggest that investments in upgraded prescription
drug-monitoring programs will pay dividends in lives saved,” he
said.
Patrick, a pediatrician at Vanderbilt University School of Medicine
in Nashville, Tennessee, specializes in treating newborn babies. He
began studying the effectiveness of drug-monitoring programs after
treating a spate of infants born struggling with the symptoms of
withdrawal from opioids doctors had prescribed to their mothers.
More than 40 Americans die every day from prescription opioid
overdoses, according to the U.S. Centers for Disease Control and
Prevention. Prescribing and sales of opioids, including the
painkillers oxycodone (Oxycontin) and hydrocodone (Vicodin), have
quadrupled since 1999, fueling the epidemic.
Pregnant women and their unborn babies have not been immune. The
incidence of neonatal abstinence syndrome in the U.S. nearly tripled
from 2000 to 2009, Patrick’s previous research showed. Many of the
mothers of newborns Patrick treated said they had no idea that
taking a doctor-prescribed pain reliever could lead them and their
unborn children to addiction.
Patrick’s new study in Health Affairs examined mortality data from
1999 through 2013 to evaluate the effectiveness of state
prescription drug-monitoring programs.
The programs are designed to prevent patients from shopping for
drugs from multiple providers or “doctor shopping” and to identify
physicians who prescribe abnormally high doses of substances or
“pill mills,” the authors write. The programs also can facilitate
conversations between doctors and patients and referrals to
drug-rehabilitation programs.
Missouri is the only state in the nation without a drug-monitoring
program, and its opioid-related overdose death rate has grown faster
than the national average, according to the study.
The average opioid overdose death rate for the 34 states included in
the current study rose from 1.4 per 100,000 in 1999 to 6.2 per
100,000 in 2013.
Average annual death rates dropped by 1.12 per 100,000 in states
that implemented drug-monitoring programs, the study found.
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A study last month in Health Affairs found that doctors in states
that track painkiller prescriptions were nearly one-third less
likely to offer patients dangerously addicting opioids.
Other previous studies found drug-monitoring programs effectively
reduced doctor shopping, opioid diversion and inappropriate
prescribing, the authors of the current study write.
Dr. Silvia Martins, a substance-abuse researcher at Columbia
University Mailman School of Public Health in New York City, said in
a phone interview that she was not surprised by the new study’s
findings.
“I would expect prescription drug-monitoring programs to have an
effect in reducing opioid deaths,” said Martins, who was not
involved in the current study. “That’s what we hope they do.”
“We need to have more data, and we need to have more time to
understand how they work and to understand which characteristics
work,” she said.
The new study lacked sufficient data to analyze the value of
programs that order physicians to register for and use
drug-monitoring programs. But Patrick and Martins both said they are
eager to see research on the effectiveness of mandatory doctor
registration in future studies.
Nonetheless, Martins cautioned that “prescription drug-monitoring
programs are just one of the tools to curb the prescription-opioid
epidemic.”
“This may be a way to identify someone and get them to treatment. It
can help facilitate a conversation with a physician,” Patrick said.
“We’re beginning as a society to think about pain in a different
way,” he said. “Are we using these drugs appropriately? If not, what
other strategies do we have?”
SOURCE: http://bit.ly/29iWr0P Health Affairs, July 2016.
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