The implementation of comprehensive prescription drug monitoring programs (PDMPs) can be associated with lower rates of opioid prescriptions in the Medicaid population, as well as lower rates of opioid-related inpatient stays and emergency department (ED) visits, according to research published in the September issue of Health Affairs.
Researchers from Weill Cornell Medical College, the University of Kentucky College of Public Health, and Rollins School of Public Health in Atlanta noted that while PDMPs—statewide electronic databases that collect and monitor prescribing and dispensing information on controlled substances—have been recognized as one of the promising tools for regulating opioid prescribing practices and slowing the epidemic, and have been established in all 50 U.S. states, participation in the programs has varied across states and remained generally low.
The idea is that these databases can help providers identify high-risk people and high-risk patterns such as high-dosage prescriptions, dangerous drug combinations, and multiple-provider episodes. The researchers cited that the economic cost of the opioid crisis was estimated at $504 billion in 2015, or 2.8 percent of the total gross domestic product.
In 2012, Kentucky implemented the nation’s first comprehensive PDMP mandate, which requires all prescribers and dispensers to register with the state’s PDMP and use the system before the initial prescribing of any Schedule II–IV substance and at least every three months thereafter, the researchers noted. Several other states that followed suit and implemented comprehensive PDMP mandates saw rapid increases in registration with and use of PDMPs, they added.
For the study, researchers used opioid prescription data derived from the State Drug Utilization Data of the Centers for Medicare and Medicaid Services (CMS). The opioid-related hospital use data came from the files of the Agency for Healthcare Research and Quality’s Healthcare Cost and Utilization Project, and the data used was from the first quarter of 2011 through the last quarter of 2016.
The researchers first looked at the opioid prescription rate, defined as the number of opioid prescriptions covered by Medicaid per 1,000 Medicaid enrollees per quarter. The findings revealed that a state implementation of comprehensive PDMP mandates was associated with a reduction in the opioid prescription rate from 161.47 to 147.07 per 1,000 enrollees per quarter—or an 8.92 percent reduction.
Regarding the rates of opioid-related inpatient stays and ED visits, the researchers found significant reductions associated with comprehensive mandates. Specifically, the implementation of comprehensive mandates was associated with a 4.27 percent reduction in the number of opioid-related inpatient discharges, from 97.50 to 93.34 per 100,000 enrollees per quarter. Further, they found a 17.75 percent reduction in the number of opioid-related ED discharges associated with the implementation of comprehensive mandates, from 74.60 to 61.36.
“Our estimated annual reductions of approximately 12,000 inpatient stays and 39,000 ED visits could save over $155 million in Medicaid spending, a fact that deserves policy attention when states attempt to strengthen and refine PDMPs to better tackle the opioid crisis,” the researchers stated.
The study’s authors further noted that an often-voiced concern is that the increasing state policies to restrict access to prescription opioids may push people who have already become dependent on opioid to seek alternative, more dangerous, drugs such as heroin and illicitly manufactured fentanyl. To this point, the researchers admitted that they “could not rule out the possibility that the implementation of comprehensive mandates was associated with an increase in adverse events related to heroin and synthetic opioids—although those increases, if any, were offset by the reduction in prescription opioid–related events.”
