The effectiveness of prescription drug monitoring programs at reducing opioid-related harms and consequences: a systematic review

Rhodes, Emily; Wilson, Maria; Robinson, Alysia; Hayden, Jill A.; Asbridge, Mark

doi:10.1186/s12913-019-4642-8

Cited by 85 publications

(63 citation statements)

References 46 publications

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“…74 A more recent systematic review, however, found no consistent association between population-level opioid-related harms (including heroin use and overdoses) and PDMP CDSSs. 85 We also noted a conflict of interest in some studies where the developers were also the evaluators. Systematic reviews in other fields have demonstrated that when the CDSS evaluator is also the developer, outcomes are better.…”

Section: Discussionmentioning

confidence: 99%

Clinical Decision Support Systems for Opioid Prescribing for Chronic Non-Cancer Pain in Primary Care: A Scoping Review

et al. 2020

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Background and Objectives: Clinical decision support systems (CDSSs) may help clinicians prescribe opioids for chronic noncancer pain (CNCP) more appropriately. This scoping review determined the extent and range of the current evidence on CDSSs for opioid prescribing for CNCP in primary care, and whether investigators followed best evidence and current guidance in designing, implementing and evaluating these complex interventions. Methods: We searched 9 electronic databases and other data sources for studies from January 1, 2008 to October 11, 2019. Two reviewers independently screened the citations. One reviewer extracted data and a second verified for accuracy. Inclusion criteria: study of a CDSS for opioid prescribing for CNCP in a primary care clinical setting. We reported quantitative results in tables and qualitative results in narrative form. Results: Our search yielded 5068 records, of which 14 studies met our inclusion criteria. All studies were conducted in the United States. Six studies examined local (eg, health center) CDSSs and 8 examined prescription drug monitoring program CDSSs. Three CDSSs incorporated evidence-based components. Study aims were heterogeneous and study designs included both quantitative and qualitative methodologies. No studies assessed patient health outcomes. Few studies appeared to be following guidance for evaluating complex interventions. Conclusions: Few studies have rigorously assessed the use of CDSSs for opioid prescribing for CNCP in primary care settings. Going forward, investigators should include evidence-based components into the design of CDSSs and follow guidance for the development and evaluation of complex interventions.

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Section: Discussionmentioning

confidence: 99%

Clinical Decision Support Systems for Opioid Prescribing for Chronic Non-Cancer Pain in Primary Care: A Scoping Review

et al. 2020

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“… 34 While state variability cannot be controlled by the institution, the ease of use at each institution is often a topic of consideration when exploring how to improve the effect of the PDMP. 31 Oftentimes, information in the PDMP is unorganized or challenging to analyze during a busy ED workflow. 35 In addition, clinician training on how to use the PDMP also varies at each institution, often leaving busy emergency physicians with limited expertise regarding efficient use and extraction of pertinent data from the typically external PDMP.…”

Section: Discussionmentioning

confidence: 99%

Effect of a Prescription Drug Monitoring Program on Emergency Department Opioid Prescribing

Gupta

Boehmer

Giampetro

et al. 2021

WJEM

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Introduction Our goal was to determine whether implementation of a prescription drug monitoring program (PDMP) altered emergency department (ED) opioid prescription rates overall and in patients of different pain severities. Methods We conducted this single-center, retrospective review at an academic ED. The study examined patients discharged from the ED who received opioid prescriptions, before and after the state’s implementation of a PDMP (August 25, 2016). The monthly rate was a ratio of the patients given ≥ 1 opioid prescription to the ED patients with a numeric pain rating scale (NPRS) > 0. We performed an interrupted time series analysis on each demographic. Results The overall ED opioid prescription rate decreased from 51.3% (95% confidence interval [Cl], 50.4%–52.2%) to 47.9% (95% Cl, 47.0%–48.7%). For males, this decreased from 51.1% to 46.7% (P < 0.0001), while in females it did not significantly change (51.6% to 49.7% [P = 0.0529]). For those with mild pain, the rate increased from 27.5% to 34.3% (P < 0.0001), while for those with moderate pain, it did not significantly change (42.8% to 43.5% [P = 0.5924]). For those with severe pain, the rate decreased from 66.1% to 59.6% (P < 0.0001). Conclusion We found that PDMP implementation was associated with an overall decrease in opioid prescription rates, and that patients with mild pain were prescribed opioids more often while severe pain patients were prescribed opioids less often.

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“…Finally, we acknowledge the potential for adverse consequences resulting from rapid reduction or withdrawal of prescriptions for people taking opioids that have been observed elsewhere, including the USA and Canada, such as a shift towards use of illicit opioids [15,16,17]. We also recognise that each country is unique and may have specific drivers for opioid prescribing which require tailored and patient-focussed responses.…”

Section: Implications For Policy and Practicementioning

confidence: 96%

“…It also reflects the cultural and social standpoints and practices of clinical, legal and regulatory communities which fluctuate over time, as documented in the narrative review by Rosenblum and colleagues [14]. Some countries, including the USA and Canada, have responded to these concerns through increased monitoring or regulation of these prescriptions, although these measures have been associated with some unwelcome, unintended consequences such as increased use of illicit opioids [15,16,17].…”

Section: Introductionmentioning

confidence: 98%

Quantifying prescribed high dose opioids in the community and risk of overdose

et al. 2021

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Background Opioid prescribing for a range of health issues is increasing globally. The risk of fatal and non-fatal overdose is increased among people prescribed strong opioids: in high doses in the context of polypharmacy (the use of multiple medications at the same time), especially with other sedatives; and among people with multiple morbidities including cardiorespiratory, hepatic and renal conditions. This study described and quantified the prescribing of strong opioids, comorbidities and other overdose risk factors among those prescribed strong opioids, and factors associated with high/very high opioid dosage in a regional health authority in Scotland as part of a wider service improvement exercise. Methods Participating practices ran searches to identify patients prescribed strong opioids and their characteristics, polypharmacy, and other overdose risk factors. Data were anonymised before being analysed at practice and patient-level. Morphine Equivalent Doses were calculated for patients based on drug/dose information and classed as Low/Medium/High/Very High. Descriptive statistics were generated on the strong opioid patient population and overdose risk factors. The relationship between the prescribing of strong opioids and practice/patient-level factors was investigated using linear and logistic regression models. Results Eighty-five percent (46/54) of GP practices participated. 12.4% (42,382/341,240) of individuals in participating practices were prescribed opioids and, of these, one third (14,079/42,382) were prescribed strong opioids. The most common comorbidities and overdose risk factors among strong opioid recipients were pain (67.2%), cardiovascular disease (43.2%), and mental health problems (39.3%). There was a positive significant relationship between level of social deprivation among practice caseload and level of strong opioid prescribing (p < 0.001). People prescribed strong opioids tended to be older (mean 59.7 years) and female (8638, 61.4%) and, among a subset of patients, age, gender and opioid drug class were significantly associated with prescribing of High/Very High doses. Conclusions Our findings have identified a large population at potential risk of prescription opioid overdose. There is a need to explore pragmatic models of tailored interventions which may reduce the risk of overdose within this group and clinical practice may need to be tightened to minimise overdose risk for individuals prescribed high dose opioids.

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The effectiveness of prescription drug monitoring programs at reducing opioid-related harms and consequences: a systematic review

Cited by 85 publications

References 46 publications

Clinical Decision Support Systems for Opioid Prescribing for Chronic Non-Cancer Pain in Primary Care: A Scoping Review

Clinical Decision Support Systems for Opioid Prescribing for Chronic Non-Cancer Pain in Primary Care: A Scoping Review

Effect of a Prescription Drug Monitoring Program on Emergency Department Opioid Prescribing

Quantifying prescribed high dose opioids in the community and risk of overdose

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