One Way to Decrease Opioid Overdoses: Track Prescriptions

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Requirements to check a prescription database lead to fewer opioid overdoses, according to new research by Michigan Ross Professor Tom Buchmueller.

The U.S. is still in the midst of a staggering opioid crisis, with 116 deaths each day resulting from overdoses according to U.S. Health and Human Services. Prescription drugs are a well-documented precursor: 80 percent of heroin addicts report misusing prescription drugs prior to starting heroin.

Buchmueller

New research from Ross Professor Tom Buchmueller offers a simple but effective solution: Requiring doctors to check a statewide opioid prescription database before issuing a new painkiller prescription has proven to result in fewer overall prescriptions and fewer overdoses.

Buchmueller studied the use of PDMPs, prescription drug monitoring programs, which are used by every state except Missouri. A PDMP serves as a database that allows pharmacies, physicians, and law enforcement officers to view a patient’s history with certain kinds of drugs that are proven to be addictive, such as oxycodone and vicodin.  

This means that patients who are doctor-shopping and receiving more prescriptions than needed, or doctors who are prescribing large amounts of painkillers and serving as a “pill mill,” can be more easily discovered.

PDMPs have been lauded as an effective response to the opioid crisis.

In 2016, states received $1 billion in funding for PDMPs from the 21st Century Cures Act of 2016. But Buchmueller’s research discovered that not every state with a PDMP system has benefited from it.

That’s because state laws vary widely on the required use of PDMPs. Some states only mandate that new patients must be cleared by the system, or that only certain healthcare settings, such as pain clinics, must use them.

After analyzing Medicare data from all states from 2007-2013, Buchmueller and his co-author, Colleen Carey of Cornell University, found that PDMPs were most effective in states with a “must access” law in which all prescribers were required to use the database before prescribing certain addictive drugs.

“When New York implemented a strong ‘must access’ provision in 2013, the number of registrants increased by a factor of 14 and the number of daily queries rose from fewer than 400 to more than 40,000,” Buchmueller wrote in the Public Health Post. “When similar provisions were implemented in Kentucky, Tennessee, and Ohio, the number of providers registered and the number of queries received per day increased by orders of magnitude.”

Buchmueller and Carey also analyzed the percentage of patients receiving prescriptions from five or more prescribers or pharmacies — a potential sign of doctor-shopping and drug overuse — relative to the implementation of must-access laws. After must-access regulation took effect, there was a significant decline in apparent doctor shopping.

He cautions that one of the most important factors for a PDMP to be truly effective, besides the requirement to use it, is also its ease of use. It should to be integrated with the electronic records system that the prescriber already uses, which can be costly. States can apply for federal funding to help integrate their PDMP systems.

Seventeen states, including Michigan, have now implemented must-access laws, Buchmueller said.