Impact of a Mandatory Prescription Drug Monitoring Program on Prescription of Opioid Analgesics by Dentists

Abstract

Prescription Drug Monitoring Programs (PDMP) are statewide databases that collect data on prescription of controlled substances. New York State mandates prescribers to consult the PDMP registry before prescribing a controlled substance such as opioid analgesics. The effect of mandatory PDMP on opioid drug prescriptions by dentists is not known. This study investigates the impact of mandatory PDMP on frequency and quantity of opioid prescriptions by dentists in a dental urgent care center. Based on the sample size estimate, we collected patient records of a 3-month period before and two consecutive 3-month periods after the mandatory PDMP implementation and analyzed the data on number of visits, treatment types and drug prescriptions using Chi-square tests. For patients who were prescribed pain medications, 452 (30.6%), 190 (14.1%), and 140 (9.6%) received opioid analgesics in the three study periods respectively, signifying a statistically significant reduction in the number of opioid prescriptions after implementation of the mandatory PDMP (p<0.05). Total numbers of prescribed opioid pills in a 3-month period decreased from 5096 to 1120, signifying a 78% reduction in absolute quantity. Prescriptions for non-opioid analgesics acetaminophen increased during the same periods (p<0.05). We conclude that the mandatory PDMP significantly affected the prescription pattern for pain medications by dentists. Such change in prescription pattern represents a shift towards the evidence-based prescription practices for acute postoperative pain.

Overprescribing of Opioids to Adults by Dentists in the U.S., 2011–2015

“…Even though nonopioid analgesics have been shown to achieve equivalent or superior pain control for acute oral pain, 43 a recent comparison of opioid prescribing by dentists in the U.S. and England suggests that opioid prescribing by U.S. dentists, especially for high-potency opioids, is excessive. 4 Interventions that have been shown to be effective in curtailing opioid prescribing by dentists include mandatory query of the state prescription drug monitoring program 1 and pharmacist-delivered audit and feedback. 44 However, dentists have low registration and use of prescription drug monitoring programs.…”

Dental opioid prescribing and multiple opioid prescriptions among dental patients

“…Although initial evidence suggests that mandatory use policies decrease dental opioid prescribing, in the absence of mandated use, rates of registration and use of PDMP are strikingly low among dentists. (22, 46) The proactive use of a PDMP offers a clinical care coordination tool and affords dentists the opportunity to identify patients with pre-existing, recently dispensed opioids and engage these patients in clinically oriented discussions regarding the pros and cons of their acute post-operative dental pain management options. For practitioners interested in learning more about their state’s PDMP, information may be found in Table 3.…”

How Good Intentions Contributed to Bad Outcomes: The Opioid Crisis

“…This measure is associated with a modest and sustained decrease in opioid prescriptions as has been found by the mandatory prescribing drug monitoring program on opioid prescriptions by dentists in New York. 56,57 In April 2017, federal legislation was introduced to limit the supply of opioid prescription for acute pain to 7 days. 58 By August 2017, 24 states have enacted legislation with a limit, guidance, or requirement related to opioid prescribing.…”