Association Between Prescription Drug Monitoring Programs and Nonfatal and Fatal Drug Overdoses

Fink, David S.; Schleimer, Julia P.; Sarvet, Aaron L.; Grover, Kiran; Delcher, Chris; Castillo‐Carniglia, Álvaro; Kim, June H.; Rivera‐Aguirre, Ariadne; Henry, Stephen G.; Martins, Sílvia S.; Cerdá, Magdalena

doi:10.7326/m17-3074

Cited by 194 publications

(158 citation statements)

References 33 publications

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“…PDMPs differ greatly between states, and legal mandates for PDMP use by prescribers and pharmacists have been limited until recently. Furthermore, there is a current lack of PDMP integration into EMRs and pharmacy operating systems which limits their accessibility and subsequent use . Pharmacists should realize that electronic resources like PDMPs are one of several tools to be used together to evaluate opioid misuse risk and to maintain patient engagement.…”

Section: Discussionmentioning

confidence: 99%

“…Pharmacists should realize that electronic resources like PDMPs are one of several tools to be used together to evaluate opioid misuse risk and to maintain patient engagement. Some PDMPs and supply‐side policies may potentially end up unintentionally harming patients if not combined with expansion of treatment and harm reduction interventions like naloxone …”

Section: Discussionmentioning

confidence: 99%

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Pharmacists and the opioid crisis: A narrative review of pharmacists' practice roles

Bratberg

Smothers

Collins

et al. 2019

J Am Coll Clin Pharm

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Introduction Nearly 2.5 million Americans have an opioid use disorder (OUD) related to prescription and/or illicit opioids. Pharmacists, as one of the most accessible care providers, are essential in mitigating the mortality and morbidity of the opioid overdose crisis. Pharmacists are involved in numerous care activities related to this crisis and to caring for patients with an OUD. Objective The objective of this paper was to conduct a literature review to highlight several pharmacist‐driven practices that provide a broad range of prevention, harm reduction, treatment, and recovery services to patients affected or potentially affected by the opioid crisis. Methods Articles had to meet the criteria of describing pharmacist‐led practice related to providing care to patients at risk of an opioid overdose, with an OUD, or related to opioid safety. The literature search was conducted in 2018 and utilized numerous sources including: OneSearch (EBSCOhost), PubMed, ScienceDirect, and the Journal of the American Pharmacists Association Opioid Topic Collection. Results Seven articles were chosen for inclusion in this review. These studies report on innovative programs and practices that describe the role of pharmacists in the opioid crisis. Studies demonstrate the types of involvement pharmacists have in caring for patients throughout the care continuum: actively engaged in upstream interventions aimed at preventing misuse and improve safety; screening and monitoring opioid prescribing and usage; providing access to naloxone; and, assisting in the recovery and rehabilitation process of patients with OUD, including collaboratively managing OUD with evidence‐based pharmacotherapy. Conclusion The studies included in our narrative review demonstrate how innovative programs and practices can expand the role of pharmacists throughout the entire spectrum of interventions applied to the opioid crisis by capitalizing on their existing skill sets and knowledge.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Pharmacists and the opioid crisis: A narrative review of pharmacists' practice roles

Bratberg

Smothers

Collins

et al. 2019

J Am Coll Clin Pharm

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“…We examined references from the selected materials to identify additional articles that met the inclusion criteria. To ensure that we captured all relevant studies, we compared our yielded articles with the evaluations included in the following review papers: Haegerich et al., 2014; Beaudoin et al., 2016; Finley et al., 2017; and Fink et al., 2018 . We conducted the search in summer 2018 and no additional articles were added after September 1, 2018.…”

Section: Methodsmentioning

confidence: 99%

“…Previous studies aggregated evidence from specific interventions and integrated strategies in a single review . Reviews published in the past two years of prescription drug monitoring program (PDMP) evaluations are inconclusive with regard to PDMP effects on overdose and other outcomes . Reviews that synthesize evaluations of multiple interventions published prior to 2016 identified some promising state policies to decrease opioid prescribing, including PDMPs, policies targeting insurance practices, pain clinic regulations, clinical guidelines, and naloxone access laws .…”

Section: State Policies To Curb Opioid Misusementioning

confidence: 99%

The Association of State Opioid Misuse Prevention Policies With Patient‐ and Provider‐Related Outcomes: A Scoping Review

2019

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This scoping review reveals a growing literature on the effects of certain state opioid misuse prevention policies, but persistent gaps in evidence on other prevalent state policies remain. Policymakers interested in reducing the volume and dosage of opioids prescribed and dispensed can consider adopting robust prescription drug monitoring programs with mandatory access provisions and drug supply management policies, such as prior authorization policies for high‐risk prescription opioids. Further research should concentrate on potential unintended consequences of opioid misuse prevention policies, differential policy effects across populations, interventions that have not received sufficient evaluation (eg, Good Samaritan laws, naloxone access laws), and patient‐related outcomes. Context In the midst of an opioid crisis in the United States, an influx of state opioid misuse prevention policies has provided new opportunities to generate evidence of policy effectiveness that can inform policy decisions. We conducted a scoping review to synthesize the available evidence on the effectiveness of US state interventions to improve patient and provider outcomes related to opioid misuse and addiction. Methods We searched six online databases to identify evaluations of state opioid policies. Eligible studies examined legislative and administrative policy interventions that evaluated (a) prescribing and dispensing, (b) patient behavior, or (c) patient health. Findings Seventy‐one articles met our inclusion criteria, including 41 studies published between 2016 and 2018. These articles evaluated nine types of state policies targeting opioid misuse. While prescription drug monitoring programs (PDMPs) have received considerable attention in the literature, far fewer studies addressed other types of state policy. Overall, evidence quality is very low for the majority of policies due to a small number of evaluations. Of interventions that have been the subject of considerable research, promising means of reducing the volume and dosages of opioids prescribed and dispensed include drug supply management policies and robust PDMPs. Due to low study number and quality, evidence is insufficient to draw conclusions regarding interventions targeting patient behavior and health outcomes, including naloxone access laws and Good Samaritan laws. Conclusions Recent research has improved the evidence base on several state interventions targeting opioid misuse. Specifically, moderate evidence suggests that drug supply management policies and robust PDMPs reduce opioid prescribing. Despite the increase in rigorous evaluations, evidence remains limited for the majority of policies, particularly those targeting patient health–related outcomes.

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“…How PDMPs are structured and operated (e.g., functionality, funding, oversight and evaluation, data sharing, and prescriber and dispenser requirements) varies among states and across time. Such heterogeneity may modify PDMP effectiveness but has often been overlooked in prior studies …”

Section: Introductionmentioning

confidence: 99%

Prescription drug monitoring programs: Assessing the association between “best practices” and opioid use in Medicare

Moyo

Simoni

Griffin

et al. 2019

Health Services Research

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Objective To estimate the impact of implementing prescription drug monitoring program (PDMP) best practices on prescription opioid use. Data Sources 2007–2012 Medicare claims for noncancer pain patients, and PDMP attributes from the Prescription Drug Abuse Policy System. Study Design We derived PDMP composite scores using the number of best practices adopted by states (range: 0‐14), classifying states as either no PDMP, low strength (0 < score < median), or high strength (score ≥ median). Using generalized linear models, we quantified the association between the PDMP score category and opioid use measures—overall and stratified by disability/age. Sensitivity analyses assessed the general Medicare sample regardless of pain diagnoses, individual PDMP characteristics, and compared GEE model findings to models with state fixed effects. Principal Findings Compared to non‐PDMP states, strong PDMP states had lower opioid cumulative doses (−296 mg; 95% CI: −512, −132), days supplied (−7.84; 95% CI: −10.6, −5.04), prescription fill rates (0.97; 95% CI: 0.95, 0.98), and mean daily doses (−2.31 mg; 95% CI: −3.14, −1.48) but greater prevalence of high opioid doses in disabled adults, whereas there was little or no change in older adults. Findings in states with weak PDMPs were substantively similar to those of strong PDMPs. Results from sensitivity analyses were mostly consistent with main findings except there was a null relationship with mean daily doses and high doses in models with state fixed effects. Conclusions Comprehensive or minimal adoption of PDMP best practices was associated with mostly comparable effects on Medicare beneficiaries’ opioid use; however, these effects were concentrated among nonelderly disabled adults.

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Association Between Prescription Drug Monitoring Programs and Nonfatal and Fatal Drug Overdoses

Cited by 194 publications

References 33 publications

Pharmacists and the opioid crisis: A narrative review of pharmacists' practice roles

Pharmacists and the opioid crisis: A narrative review of pharmacists' practice roles

The Association of State Opioid Misuse Prevention Policies With Patient‐ and Provider‐Related Outcomes: A Scoping Review

Prescription drug monitoring programs: Assessing the association between “best practices” and opioid use in Medicare

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