Mandating that prescribers use prescription drug monitoring programs (PDMPs) is the single most effective way to increase prescriber use of the tool, which can play a critical role in curbing prescription opioid misuse, according to a report by Pew Charitable Trusts and researchers at Brandeis University.
The report from Pew Charitable Trusts and the Institute for Behavioral Health, Heller School for Social Policy and Management at Brandeis University, focuses on how states can help curb opioid misuse and specifically examines PDMPs and evidence-based practices to optimize prescriber use of PDMPs. The report outlines eight evidence-based practices aimed at increasing prescriber utilization of PDMPs.
“Of the eight practices, mandates are the single most effective way to increase prescriber use,” the report stated. “But a mandate alone does not mean that prescribers will use the PDMP effectively in clinical decision-making. Therefore, state officials should explore the other seven strategies and adopt a combination of practices that works best for their program. PDMPs can play a critical role in curbing prescription opioid misuse, but only if states take steps to ensure that the data are easy to access and understand.”
As the opioid crisis continues to impact communities across the country, policymakers and public health officials are increasingly using new tools such as PDMPs—state-based electronic databases that track the dispensing of certain controlled substances—to stem the misuse of prescription opioids and reduce overdose deaths. According to the report authors, these programs can help reduce the misuse and “diversion”—the redirection of drugs from legal, medically authorized uses to illegal uses—of controlled substances, including prescription opioids.
While the number of PDMPs has grown rapidly in the past 15 years, with programs now operational in all states (with the exception of Missouri), Guam, and the District of Columbia, the number of prescribers utilizing PDMPs remains low, thus limiting the effectiveness of these databases, according to the report. Twenty-two states with PDMPs don’t require prescribers to use them and only 26 percent of states have a comprehensive prescriber use mandate.
The prescription opioid epidemic poses major threats to the nation’s health. According to the Centers for Disease Control and Prevention, approximately 19,000 people in the United States died from overdoses involving prescription opioids in 2014—a 16 percent increase from the previous year, and the highest number ever recorded, the report states. Emergency room visits by people using opioids for nonmedical reasons, such as taking a higher-than-prescribed dose or a prescription intended for another person, increased 117 percent between 2005 and 2011. Furthermore, people who are addicted to prescription opioids are 40 times more likely to become addicted to heroin. And the rate of deaths involving heroin increased nearly fivefold between 1999 and 2014, with more than 10,500 people dying of heroin-related overdoses in 2014, the report states.
“Because increased prescribing of opioids has been a primary driver of the prescription opioid epidemic, reducing the overprescribing of these therapies is a primary focus of efforts to reverse these trends,” the report authors state.
The Pew Charitable Trusts report recommends states adopt one or more of the following evidence-based practices to increase prescriber use of PDMPs:
· Prescriber use mandates, or state laws and regulations that require prescribers to view a patient’s PDMP data under certain circumstances. Mandates can rapidly increase PDMP utilization and immediately affect prescriber behavior, which can help prevent “doctor shopping”—when patients seek the same or similar drugs from multiple prescribers and pharmacies in a short period.
· Delegate access, which allows prescribers to authorize someone on staff, such as a nurse or other member of the health care team, to access the PDMP data on their behalf. The majority of states allow delegate access; evidence suggests such access addresses workflow barriers and increases PDMP use.
· Unsolicited reports, where prescribers are proactively notified about patients who may be at risk for harm based on their controlled substance prescription history. These alerts can help increase prescriber use in two ways: by motivating them to review patient data and informing unenrolled prescribers about the existence of the PDMP.
· Improving data timeliness, or increasing the frequency at which data are uploaded into PDMP databases. Many states now require dispensers to upload new data on a daily basis, which increases the timeliness of information and encourages PDMP use.
· Streamlining enrollment by making it easier for prescribers and delegates to register with their state PDMPs. Enrollment is required before clinicians can check PDMP data, so making this process faster and easier can increase use.
· Educational and promotional initiatives that help prescribers understand how PDMPs work and encourage their use. Such activities can spur enrolled prescribers and delegates to check PDMP data and inform unenrolled clinicians about the value of these databases.
· Integrating PDMP data with health information technology, which helps prescribers seamlessly access PDMPs through electronic health records or other IT systems. Pilot projects across the country found that prescribers reported PDMP data were easier to access when the system was integrated into daily workflows.
Enhancing PDMP user interfaces, or redesigning how data are presented, to help prescribers more quickly analyze prescribing information and make better-informed decisions.
According to the report authors, of the eight practices, evidence shows that prescriber use mandates are the single most efficient means for increasing prescriber utilization. “However, mandating database queries does not guarantee that prescribers will make effective use of PDMP data in their prescribing decisions. Determining the optimum conditions, such as the timing triggers for required checks and exemptions, will require continued monitoring and comparison of outcomes among the states that have adopted them,” the report authors wrote.