PAIN MANAGEMENT

Prescription-drug monitoring cuts doctor-shopping for painkillers

 (Reuters)

State programs that require physicians to check drug registries before writing prescriptions appeared to slash the odds of doctor-shopping for opioid pain relievers, a new study found.

"Our study shows that prescription-drug monitoring programs are a promising component of a multifaceted strategy to address the opioid epidemic," Ryan Mutter, one of the study authors, said in a phone interview. He is a health economist at the Substance Abuse and Mental Health Service Administration in Rockville, Maryland.

Mutter and other researchers analyzed annual nationwide surveys of drug use and health from 2004 until 2014, when 36 states implemented prescription-drug monitoring programs, or PDMPs.

PDMPs are state-run electronic databases designed to track prescribing of controlled substances and to identify people at high risk of using opioids for nonmedical purposes. Every state except Missouri now has a drug-monitoring program. Some states have mandatory programs requiring physicians to participate, and other states have voluntary programs.

The study, reported in the journal Addictive Behaviors, found that in states where physicians were required to check an electronic database before writing an opioid prescription, the odds that two or more doctors would be giving pain relievers for nonmedical purposes to a single patient were reduced by 80 percent. States that implemented voluntary monitoring programs showed a 56 percent reduction in the odds of doctor-shopping.

States with mandatory prescription-drug monitoring programs reduced the use of painkillers for nonmedical purposes by an average of 20 days a year, the study found. States with voluntary prescription-drug monitoring program reduced the use of painkillers for nonmedical purposes by an average of 10 days a year.

"Overall, this, as well as other studies, suggests there's promise for prescription-drug monitoring programs," Dr. Stephen W. Patrick said in a phone interview. "But they aren't a panacea."

"We really need a comprehensive approach. It isn't one thing that will help get us out of the opioid epidemic," said Patrick, a pediatrician at Vanderbilt University School of Medicine in Nashville, Tennessee. He treats newborns struggling with the symptoms of withdrawal from opioids prescribed to their mothers and was not involved in the new study.

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Every day, 91 Americans die from an opioid overdose, according to the U.S. Centers for Disease Control and Prevention. Since 1999, deaths from prescription opioids have quadrupled, as have sales of opioids, including the painkillers oxycodone (Oxycontin) and hydrocodone (Vicodin).

The number of PDMPs has expanded rapidly across states since 2000, but prior studies have shown mixed results about their effectiveness, the study authors write.

One previous study found that drug-monitoring programs help prevent 10 opioid-overdose deaths a day in the U.S., yet improvements could save another two people a day. States with the most robust programs - ones that tracked a greater number of potentially addictive medications and updated their databases at least weekly - saw the biggest drops in overdose deaths, the previous study showed.

Public health advocates worry that an unintended consequence of drug-monitoring programs could be that opioid users would seek drugs illegally and turn to heroin, the authors write. But the current study found that PDMPs did not lead to an increase in people starting to use heroin.

Lead author Mir M. Ali said in a phone interview he found it "reassuring" that drug-monitoring programs were not responsible for opioid users substituting heroin. Ali is a health economist at the Substance Abuse and Mental Health Services Administration.

"In any situation where you're limiting supply, people might begin to substitute," Patrick said. "What we really need to do is focus on how we get control of the prescription opioid epidemic."