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 The launch of drug-monitoring programs in 24 states led to an
immediate 30 percent drop in prescriptions for Schedule II opioids,
the most addictive, in patients with pain complaints, the study
showed.
“We are moving in the direction of raising awareness about
overprescribing these drugs,” lead author Yuhua Bao said in a phone
interview. “But we still have a lot to do in terms of changing the
culture and practice of painkiller prescriptions.”
Bao, a health economist at Weill Cornell Medical College in New
York, and colleagues analyzed 26,275 office visits for pain in 24
states that implemented prescription drug-monitoring programs from
2001 to 2010.
As reported in Health Affairs, in these states the probability of a
doctor prescribing a Schedule II opioid dropped from 5.5 percent to
3.7 percent – a more than 30 percent reduction. The results were
immediate and held for three years.
The study confirmed Bao’s hypothesis that physician drug-monitoring
programs, which have been implemented in a wide variety of forms in
every state except Missouri, are an effective tool to combat the
opioid drug epidemic. But she stressed the need for other means as
well.
“There are no magic bullets here,” said Dr. Caleb Alexander, who
directs the Johns Hopkins Center for Drug Safety and Effectiveness
in Baltimore, in a phone interview.
“The interventions are needed along the continuum here – from
manufacturers to end-users. This is important to keep in mind given
the magnitude of addiction, injuries and deaths,” said Alexander,
who was not involved in the current study.
Nearly two million Americans either abused or were dependent on
prescription opioids in 2014, according to the US Centers for
Disease Control and Prevention (CDC).
Overdose deaths, along with sales of prescription opioids, have
quadrupled since 1999, the CDC estimates. More than 165,000
Americans died from overdoses related to prescription opioids from
1999 to 2014.
Some of these deaths might have been avoided if doctors had been
able to check a prescription drug-monitoring database, Alexander
said.
A database could show when patients are obtaining opioids under
their own name from multiple doctors, which might assist in
identifying potential abuse and dependency, he noted.
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Drug-monitoring databases may make doctors think twice before
prescribing pain medications for a variety of reasons in addition to
uncovering “doctor shopping” by patients, the study authors write.
Knowing that they’re being watched may serve as a deterrent, and the
programs may generally increase awareness of the dangers of
prescribing opioids, they say.
“Given how many people are killed by prescription opioids and how
dangerous these drugs are, it should be no less important for a
clinician to check a prescription drug-monitoring program before
prescribing an opioid than to check kidney function before
prescribing a new blood-pressure medicine,” Alexander said.
In March, the CDC released guidelines instructing primary care
doctors to sharply curtail use of opioids for chronic pain. At the
time, CDC Director Dr. Tom Frieden called the prescription overdose
epidemic “doctor-driven.”
Primary-care doctors treating adults for chronic pain write nearly
half of opioid prescriptions, the CDC said. The new guidelines
recommend non-opioids like acetaminophen and ibuprofen as the first
line of pain treatment.
Authors of the current study say American clinicians are writing
enough prescriptions to medicate every US adult for a month.
“No opioid is entirely safe,” Alexander said, “and all opioids
should be used with much greater caution than we have in the past
two decades.”
SOURCE: http://bit.ly/1Uaoty9 Health Affairs, online June 6, 2016.
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