Prescription Drug Monitoring Programs Might Have Unintended Consequences
Interacting with prescription drug monitoring programs has become routine for many pharmacists. Ideally, knowing more about patients' medication history can help prevent drug overdoses. A new study raises concerns, however, about whether that really is occurring.
NEW YORK - - New research raises a critical question about prescription drug monitoring programs (PDMPs): Do they actually increase or decrease drug overdoses among people in the United States?
An online report published by Annals of Internal Medicine notes that PDMPs are central to drug abuse prevention plans issued by the White House. The national Centers for Disease Control and Prevention calls them "among the most promising state-level interventions to improve opioid prescribing, inform clinical practice, and protect patients at risk."
A study team led by Columbia University's Mailman School of Public Health in New York and University of California, Davis, demonstrates, however, that insufficient evidence is available to confirm whether the programs have the desired effect – or the opposite.
"Our aim was to systematically search and review the literature to assess whether these programs are associated with changes in nonfatal or fatal overdoses," explained first author David Fink, MPH, MPhil, doctoral candidate in epidemiology at the Mailman School of Public Health. "The evaluations would also help us determine whether specific administrative features of PDMPs correlate with these outcomes and, if so, which elements are most influential."
Researchers conducted a meta-analysis of publications indexed on MEDLINE, Clarivate Analytics, and ProQuest Dissertations through December 2017. Out of 2,661 articles, 17 met the inclusion criteria, with 10 of them linking program implementation with reduction in fatal opioid overdoses.
The feature most studied was mandatory oversight by providers of PDMP data, which involved reviewing comprehensive prescribing history for each patient before writing prescriptions. Weekly or more updates of PDMP data, provider authorization to access PDMP data, and monitoring of nonscheduled drugs also were linked with a decrease in fatal overdoses, study authors point out.
Conversely, three studies indicated an increase in heroin overdose deaths after the monitoring programs had been implemented.
"This suggested to us that heroin substitution may have increased after PDMP-inspired restrictions on opioid prescribing," explained co-senior author Silvia Martins, MD, PhD, associate professor of epidemiology at Mailman. "We therefore caution that programs aimed at reducing prescription opioids should also address the supply and demand of illicit opioids."
The meta-analysis didn't reach all of its goals, researchers said. "We also hoped to learn of any potential unintended consequences associated with PDMPs," said co-senior author Magdalena Cerdá, DrPH, associate professor, department of emergency medicine at UC Davis. "What we found was that vast variations in programs and their administrative features make them especially challenging to study."
PDMP is either mandated or in the process of being implemented in all 50 states and the District of Columbia, the study notes. "As such, it is crucial to determine if these programs are helping to reduce opioid overdose," Fink observed. "So far, the definitive conclusion we can draw from our evaluation is that the evidence is insufficient and that much more research is needed to identify a set of 'best practices.'"