In the war against rampant opioid abuse, physicians have a powerful weapon in their arsenal—state databases that track all prescriptions written for these addictive drugs.
Almost every state has implemented Prescription Drug Monitoring Programs (PDMPs), which record a patient’s opioid prescribing history. By leveraging these databases, doctors can access information to make an informed decision about whether patients are opioid abusers.
PDMPs collect and share data on prescriptions for controlled substances to flag suspicious prescribing and utilization. However, not all states require providers to access these kinds of databases prior to writing or filling a prescription.
Researchers have found that “must access” PDMPs, which require physicians to consult them before writing prescriptions, significantly reduced opioid misuse in Medicare Part D, based on the review of 3.5 million patient records between 2007 and 2013. At the same time, their research showed that PDMPs without such mandatory provisions have no effect on curbing opioid abuse.
Unfortunately, when provider access is not mandatory, data shows that only small numbers of providers create PDMP logins and actually request patient histories.
“A great example is Kentucky, which passed a ‘must access’ requirement in 2012 and saw the share of controlled substance prescribers who had created a login rise from about a third to more than 95 percent,” says Colleen Carey, assistant professor of policy analysis and management in the College of Human Ecology at Cornell University.
According to Carey, a healthcare economist, one of the ways states can get providers to start using PDMPs is to pass laws that require physicians to check these databases for their patients' previous prescriptions. She notes that New York has the nation’s toughest laws with those requirements.
“New York (is the) strictest state requiring doctors to check the opioid history of ‘every patient, every time,’ which is stronger than any other state,” she says.
Carey and Thomas Buchmueller, a professor in the Ross School of Business at the University of Michigan, co-authored a paper detailing their findings which are to be published in an upcoming issue of the American Economic Journal: Economic Policy.
“Our results suggest that PDMPs that do not require provider participation are not effective in reducing questionable or inappropriate use of prescription opioids,” conclude Carey and Buchmueller. “We do find evidence that ‘must access’ PDMPs have the desired effect of curbing certain types of extreme utilization. Specifically, such policies reduce several measures of excessive quantity and shopping behavior. The strongest laws, which cover all ingredients and settings of care and do not require providers to be suspicious, have larger effects on utilization than weaker laws, but even ‘limited’ and ‘discretionary’ laws lower rates of shopping behavior.”
Doctor shopping is defined as seeing multiple providers to procure prescription medications illicitly. In their research on “must access” PDMPs, Carey and Buchmueller discovered that Medicare opioid users who got prescriptions from five or more physicians—a common indication of doctor shopping—dropped by 8 percent, while the percentage of those who got opioids from five or more pharmacies was reduced by 16 percent.
Nonetheless, the researchers also observe that the “passage of a ‘must access’ PDMP may prompt individuals to cross state lines in search of less-regulated prescribers and pharmacies.”
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