The Use of a Prescription Drug Monitoring Program to Develop Algorithms to Identify Providers With Unusual Prescribing Practices for Controlled Substances

Abstract

The misuse, abuse and diversion of controlled substances have reached epidemic proportion in the United States. Contributing to this problem are providers who over-prescribe these substances. Using one state's prescription drug monitoring program, we describe a series of metrics we developed to identify providers manifesting unusual and uncustomary prescribing practices. We then present the results of a preliminary effort to assess the concurrent validity of these algorithms, using death records from the state's vital records database pertaining to providers who wrote prescriptions to patients who then died of a medication or drug overdose within 30 days. Metrics manifesting the strongest concurrent validity with providers identified from these records related to those who co-prescribed benzodiazepines (e.g., valium) and high levels of opioid analgesics (e.g., oxycodone), as well as those who wrote temporally overlapping prescriptions. We conclude with a discussion of a variety of uses to which these metrics may be put, as well as problems and opportunities related to their use.

Evaluating the impact of prescription drug monitoring program implementation: a scoping review

“…An additional finding of thematic analysis was that the impacts of PDMP implementation must be considered in terms of both potential benefits and potential harms, particularly related to findings in the domains of prescribing behavior and morbidity/mortality. For example, considerable concern has been expressed about the potential for a “chilling effect” [11, 12] of PDMPs on providers’ opioid prescribing that might deprive patients of adequate pain control [13], and unclear long-term unintended consequences [14]. The resulting conceptual framework for PDMP evaluation is depicted in Fig.…”

“…With patient prescription history at their disposal, providers can not only verify the patient’s current prescriptions to avoid doctor shopping or drug abuse, but can also avoid potentially dangerous non-controlled drug interactions. As noted above, an important concern has been raised regarding the “chilling effect” that PDMPs and other opioid control measures may have on providers’ opioid prescribing, leaving patients potentially undertreated for pain or seeking elsewhere for licit or illicit means to manage their pain [11]. What happens when providers re-evaluate their opioid prescribing has proven to be a critical question, although relatively few studies have yet provided data to answer it.…”

Dental opioid prescribing and multiple opioid prescriptions among dental patients

“…Increasing evidence suggests regimens involving greater than 100 MMEs, as well as concurrent use/access to benzodiazepines, confer increased risk for overdose. (11,34–36)…”

“…When present, these conditions should raise caution and trigger further evaluation of the patient. (36–38) Use of opioids for management of acute post-operative dental pain should be avoided if possible in all of the aforementioned situations. In the rare circumstance that all non-opioid options for pain management have been exhausted, immediate release opioids should be prescribed only for the anticipated duration of moderate-to-severe pain, and dentists should take extra precaution to educate the patient regarding the risks and relative benefits.…”

The Future of Social Network Analysis of Health Care System Data: Promise and Concerns

“…One promising approach published recently involves the use of Prescription Drug Monitoring Programs (PDMPs) to develop algorithms for identifying providers with unusual prescribing practices. 9 The authors of the study suggest ways to use the algorithms to improve prescribing practices via motivation, enforcement and remediation (e.g., automated alerts to providers, involvement of licensing boards, tailored education). A multifaceted approach will likely be needed to fully address provider prescribing practices.…”