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D'Souza RS, Nahin RL. Nationally Representative Rates of Incident Prescription Opioid Use Among United States Adults and Selected Subpopulations: Longitudinal Cohort Study from the National Health Interview Survey, 2019-2020. THE JOURNAL OF PAIN 2024:104665. [PMID: 39260809 DOI: 10.1016/j.jpain.2024.104665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 07/23/2024] [Accepted: 08/31/2024] [Indexed: 09/13/2024]
Abstract
Nationally representative rates of incident prescription opioid use in the United States (U.S.) adult population and selected subpopulations are unknown. Using the National Health Interview Survey (2019-2020) longitudinal cohort, a cohort with 1-year follow-up created using random cluster probability sampling of non-institutionalized civilian U.S. adults, we estimated rates and predictors of incident opioid use. Of 21,161 baseline (2019) participants randomly chosen for follow-up, the final analytic sample included 10,415 who also participated in 2020. Exposure variables were selected per the socio-behavioral model of healthcare utilization: predisposing characteristics (sex, age, race, etc.), enabling characteristics (socioeconomic status, insurance status), health status (pain, disability, comorbidities, etc.), and healthcare use (office visits, emergency room [ER] visits, hospitalizations). Among adults who did not use prescription opioids in 2019, a one-year cumulative incidence of 4.1% (95% CI:3.5-4.6) was seen in 2020, with an incidence rate (IR) of 32.6 cases of new prescription opioid use per 1,000 person-years (PY). Cumulative incidence, IR, and adjusted relative risk (RR) varied by participant characteristics. We observed the highest IR in those with ineffective pain treatment (81.6 cases per 1,000 PY) and those who visited the ER ≥3 times (93.8 cases per 1,000 PY). Participants reporting ≥4 painful conditions had an adjusted RR of 2.9 (95% CI:2.0-4.1), while the RR for those with sleep problems was 2.3 (95% CI:1.7-3.1). Overall, this study presents nationally representative rates of incident prescription opioid use, and suggests that some participants are using prescription opioids as an early resort analgesic contrary to best practice guidelines. PERSPECTIVE: This longitudinal cohort study presents nationally representative rates of incident prescription opioid use in U.S. adults and selected subpopulations. Our data suggest that some participants are using prescription opioids as a first-line or early resort analgesic, contrary to best practice guidelines.
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Affiliation(s)
- Ryan S D'Souza
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Hospital, Rochester, MN, USA.
| | - Richard L Nahin
- National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, MD, USA
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2
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Nghiem VT, Larson MJ, Adams RS, Moresco N, Highland KB. Opioid Prescription Clusters Associated With Early or Unplanned Military Separation. Mil Med 2024; 189:e748-e757. [PMID: 37646783 PMCID: PMC10898939 DOI: 10.1093/milmed/usad339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 07/27/2023] [Accepted: 08/16/2023] [Indexed: 09/01/2023] Open
Abstract
INTRODUCTION Early/unplanned military separation in Active Component U.S. service members can result in reduced readiness during periods of high-tempo combat and increased demand for health care services within the Military Health System and Veterans Administration. Although current assessment tools leverage prescription data to determine deployment-limiting medication receipt and the need for interventions or waivers, there is a lack of understanding regarding opioid prescription patterns and subsequent early/unplanned military separation after return from deployment. As such, understanding these relationships could support future tool development and strategic resourcing. Therefore, the goal of the present study was to identify unique 12-month opioid prescription patterns and evaluate their relationship with early/unplanned military separation in Active Component service members who returned from deployment. MATERIALS AND METHODS This retrospective, IRB-approved cohort study included data from 137,654 Active Component Army service members who returned from deployment between 2007 and 2013, received a post-deployment (index) opioid prescription, and had at least 1 year of Active Component service post-opioid initiation. A k-means clustering analysis identified clusters using opioid prescription frequency, median dose, median days supply, and prescription breaks (≥30 days) over the 12-month post-initiation (monitoring) period. A generalized additive model examined whether cluster membership and additional covariates were associated with early/unplanned separation. RESULTS In addition to the single opioid prescription (38%), the cluster analysis identified five clusters: brief/moderate dose (25%), recurrent breaks (16%), brief/high dose (11%), long/few prescriptions (8%), and high prescription frequency (2%). In the generalized additive model, the probability of early/unplanned military separation was higher for the high prescription frequency cluster (74%), followed by recurrent breaks (45%), long/few prescriptions (37%), brief/moderate dose (30%), and brief/high dose (29%) clusters, relative to the single prescription (21%) cluster. The probability of early/unplanned separation was significantly higher for service members with documented substance use disorders, mental health conditions, or traumatic brain injuries during the monitoring periods. Service members assigned male were more likely to have an early/unplanned separation relative to service members assigned female. Latinx service members and service members whose race was listed as Other were less likely to experience early/unplanned separation relative to white service members. Relative to Junior Officers, Junior Enlisted and Senior Enlisted service members were more likely to experience early/unplanned separation, but Senior Officers were less likely. CONCLUSIONS Further evaluation to support the integration of longitudinal opioid prescription patterns into existing tools (e.g., a screening tool for deployment-limiting prescriptions) may enable more timely intervention and support service delivery to mitigate the probability and impact of early/unplanned separation.
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Affiliation(s)
- Vi T Nghiem
- Department of Anesthesiology, Brooke Army Medical Center, Fort Sam Houston, TX 78234, USA
| | - Mary Jo Larson
- Heller School for Social Policy and Management, Institute for Behavioral Health, Brandeis University, Waltham, MA 02453, USA
| | - Rachel Sayko Adams
- Heller School for Social Policy and Management, Institute for Behavioral Health, Brandeis University, Waltham, MA 02453, USA
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA 02118, USA
- Veterans Health Administration, Rocky Mountain Mental Illness Research Education and Clinical Center, Aurora, CO 80045, USA
| | - Natalie Moresco
- Heller School for Social Policy and Management, Institute for Behavioral Health, Brandeis University, Waltham, MA 02453, USA
| | - Krista B Highland
- Department of Anesthesiology, Uniformed Services University, Bethesda, MD 201814, USA
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Xia T, Picco L, Lalic S, Buchbinder R, Bell JS, Andrew NE, Lubman DI, Pearce C, Nielsen S. Determining the Impact of Opioid Policy on Substance Use and Mental Health-Related Harms: Protocol for a Data Linkage Study. JMIR Res Protoc 2023; 12:e51825. [PMID: 37847553 PMCID: PMC10618880 DOI: 10.2196/51825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 08/21/2023] [Accepted: 08/21/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Increasing harms related to prescription opioids over the past decade have led to the introduction of a range of key national and state policy initiatives across Australia. These include introducing a mandatory real-time prescription drug-monitoring program in the state of Victoria from April 2020 and a series of changes to subsidies for opioids on the Pharmaceutical Benefit Scheme from June 2020. Together, these changes aim to influence opioid supply and reduce harms related to prescription opioids, yet few studies have specifically explored how these policies have influenced opioid prescribing and related harms in Australia. OBJECTIVE The aim of this study is to examine the impact of a range of opioid-related policies on hospital admissions and emergency department (ED) presentations in Victoria, Australia. In particular, the study aims to understand the effect of various opioid policies and opioid-prescribing changes on (1) the number and rates of ED presentations and hospital admissions attributed to substance use (ie, opioid and nonopioid related) or mental ill-health (eg, suicide, self-harm, anxiety, and depression), (2) the association between differing opioid dose trajectories and the likelihood of ED presentations and hospital admissions related to substance use and mental ill-health, and (3) whether changes in an individual's opioid prescribing change the risk related to ED presentations and hospital admissions related to substance use and mental ill-health. METHODS We will conduct a population-level linked data study. General practice health records obtained from the Population Level Analysis and Reporting platform are linked with person-level data from 3 large hospital networks in Victoria, Australia. Interrupted time series analysis will be used to examine the impact of opioid policies on a range of harms, including the rates of presentations related to substance use (opioid and nonopioid) and mental ill-health among the primary care cohort. Group-based trajectory modeling and a case-crossover design will be used to further explore the impact of changes in opioid dosage and other covariates on opioid and nonopioid poisonings and mental ill-health-related presentations at the patient level. RESULTS Given that this paper serves as a protocol, there are currently no results available. The deidentified primary health data were sourced from electronic medical records of approximately 4,717,000 patients from 542 consenting general practices over a 6-year period (2017-2022). The submission of results for publication is planned for early 2024. CONCLUSIONS This study will add to the limited evidence base to help understand the impact of opioid policies in Australia, including whether intended or unintended outcomes are occurring as a result. TRIAL REGISTRATION EU PAS Register EUPAS104005; https://www.encepp.eu/encepp/viewResource.htm?id=104006. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/51825.
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Affiliation(s)
- Ting Xia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, Australia
| | - Louisa Picco
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, Australia
| | - Samanta Lalic
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
- Pharmacy Department, Monash Health, Clayton, Australia
| | - Rachelle Buchbinder
- Musculoskeletal Health and Wiser Health Care Units, School of Public Health and Preventive Medicine, Monash University, St Kilda, Australia
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
| | - Nadine E Andrew
- Peninsula Clinical School, Central Clinical School, Peninsula Health, Monash University, Frankston, Australia
| | - Dan I Lubman
- Turning Point, Eastern Health, Richmond, Australia
| | | | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, Australia
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Dumbhare O, Taksande A. Neonatal Abstinence Syndrome: An Insight Over Impact of Maternal Substance Use. Cureus 2023; 15:e47980. [PMID: 38034154 PMCID: PMC10686242 DOI: 10.7759/cureus.47980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
Neonatal abstinence syndrome (NAS) highlights the intricate interplay between maternal substance use during pregnancy and the challenges neonates face from the distressing global opioid crisis. This comprehensive review captures the multilayered landscape of NAS, encircling its underlying mechanisms, epidemiology, diagnostic intricacies, clinical manifestations, continuing developmental impacts, treatment paradigms, and the crucial role of multidisciplinary care. The core pathophysiology of NAS involves the transplacental passage of addictive substances, activating chemical dependence in the maturing fetus, which is characterized by neurotransmitter dysregulation, neuroadaptations, and receptor sensitization. A diverse clinical presentation ranges from central nervous system hyperactivity and autonomic dysregulation to gastrointestinal manifestations, necessitating homogenous assessment tools such as the Finnegan Neonatal Abstinence Scoring System. The demand for a multilayered approach is essential for comprehensive management, involving pharmacological interventions like morphine or methadone and non-pharmacological strategies such as swaddling. The complications of NAS are not only limited to but are also well beyond infancy, leading to behavioral, longstanding cognitive, and socioemotional consequences. Addressing these developmental arcs demands decisive longitudinal monitoring and early interventions. NAS management is fundamentally multidisciplinary, requiring the teamwork of nurses, social workers, psychologists, pediatricians, and neonatologists. Apart from the clinical realm, managing the psychosocial needs of families traversing NAS requires resources and empathy. A crucial comprehensive approach is essential to confront the challenges and limitations of NAS. From early identification and prevention to longstanding support through pharmacological, non-pharmacological, and psychological channels, it creates a holistic structure that emerges as the basis for understanding the complicated relationship between maternal substance use and its impact on neonates. An amalgamation of community engagement, society, policy initiatives, and medical expertise is essential to mitigate the repercussions of NAS and adopt healthier outcomes for affected infants.
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Affiliation(s)
- Omkar Dumbhare
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Amar Taksande
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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St. Marie BJ, Witry MJ, Reist JC. Barriers to Increasing Prescription Drug Monitoring Program Use: A Multidisciplinary Perspective. Comput Inform Nurs 2023; 41:556-562. [PMID: 36728156 PMCID: PMC10349893 DOI: 10.1097/cin.0000000000000997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Prescription drug monitoring programs are implemented through individual state policies and are one solution to curb the opioid crisis. The objectives of this study are to: (1) describe the multidisciplinary experiences using this program in practice; (2) identify limitations of the program and the desired features for improvement; and (3) characterize expectations for improved access when prescription drug monitoring programs are embedded in the electronic health record. A qualitative descriptive study design used semistructured interviews of 15 multidisciplinary healthcare providers. Textual data were analyzed using content analysis. Results showed the prescription drug monitoring program was helpful to decision-making processes related to opioid prescribing and referral to treatment; there were barriers limiting healthcare providers' use of the prescription drug monitoring program; preferences were delineated for integrating prescription drug monitoring program into electronic health record; and recommendations were provided to improve the program and increase use. In conclusion, the prescription drug monitoring program was viewed as useful in making strides to reduce the impact of inappropriate opioid prescribing in our country. By engaging a multidisciplinary group of healthcare providers, solutions were offered to improve the interface and function of the prescription drug monitoring program to assist in increasing use.
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Amin-Esmaeili M, Alinsky R, Johnson RM, Gribble A, Oyedele N, Parnham T, Goddard L, Susukida R. Impact of unsolicited reporting notifications on providers' prescribing behavior: An experimental study on Maryland PDMP data. Drug Alcohol Depend 2023; 248:109896. [PMID: 37163865 DOI: 10.1016/j.drugalcdep.2023.109896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 04/19/2023] [Accepted: 04/21/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND Unsolicited Reporting Notifications(URNs) have been a component of Maryland's Prescription Drug Monitoring Program (PDMP) since 2016. We evaluated the effect of URNs on providers' prescription behaviors. METHODS This is a quasi-experimental study of providers who were issued at least one URN from January 2018 to April 2021. Providers for whom URNs were not successfully delivered were designated as a comparison group. The outcome variables were average daily opioid and benzodiazepine prescriptions, average morphine milligram equivalents per patient, and proportion of overlapping opioid and benzodiazepine, either with or without muscle relaxant prescriptions. Changes were compared before versus after the issuance of a URN among the intervention and comparison groups using "Generalized Estimation Equation" and "Generalized Linear" Models. We also conducted stratified analyses by types of URN, including notifications for multiple provider episodes (MPE), overdose fatality (ODF), and dangerous drug combinations (DDC). RESULTS The average daily number of opioids prescriptions (3.3% decrease in the intervention group vs 22.7% increase in the comparison group, P<0.001), co-prescription of opioids and benzodiazepines either with muscle relaxants (68.0% decrease vs. 36.1% decrease, P<0.001), or without muscle relaxants (6.0% decrease vs. 16.3% increase, P<0.001), significantly reduced after the first URN regardless of the type of URN. Stratified analysis by types of URNs showed that ODF and DDC URNs had a significant effect on most of the outcomes of interest. CONCLUSION The findings suggest that unsolicited reporting, especially particular types of URNs including ODF and DDC, is associated with subsequent changes in unsafe prescribing behaviors.
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Affiliation(s)
- Masoumeh Amin-Esmaeili
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, United States.
| | - Rachel Alinsky
- Department of Pediatrics, Johns Hopkins University School of Medicine, United States; Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, United States
| | - Renee M Johnson
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, United States
| | - Anna Gribble
- Maryland Department of Health (MDH), Office of Provider Engagement and Regulation (OPER), United States
| | - Natasha Oyedele
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, United States
| | - Taylor Parnham
- Department of Health Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, United States
| | - Lindsey Goddard
- Maryland Department of Health (MDH), Office of Provider Engagement and Regulation (OPER), United States
| | - Ryoko Susukida
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, United States
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Miller C, Ilyas AM. Trends in Opioid Prescribing Following Pennsylvania Statewide Implementation of a Prescription Drug Monitoring Program. Cureus 2022; 14:e27879. [PMID: 36110459 PMCID: PMC9463719 DOI: 10.7759/cureus.27879] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2022] [Indexed: 11/12/2022] Open
Abstract
Background: The opioid epidemic is a major public health crisis in the United States. Legislators have enacted various strategies to combat this crisis, including the implementation of statewide prescription drug monitoring programs (PDMP). These PDMPs are electronic databases that collect and analyze patient prescription data on controlled substances, allowing physicians to review prior prescriptions before prescribing. The objective of this study was to determine opioid prescribing patterns after the implementation of a statewide PDMP in Pennsylvania. Methods: After IRB approval, PDMP data were obtained from the Pennsylvania Department of Health. Data obtained included: drug name, days supplied, refill count, and partially filled prescriptions. The study timeline was three years, from first quarter 2017 through first quarter 2020. Results: Over the three years post-implementation of a PDMP, Pennsylvania saw a 33% decrease in the overall quantity of opioid pills prescribed (677,194 absolute reduction), a 9% decrease in partially filled prescriptions (5,821 absolute reduction), and an 18% decrease in authorized refills (525 absolute reduction). Opioid prescriptions for greater than seven days of supply decreased by a larger amount than prescriptions for less than seven days of supply (43% vs 27%). Similarly, prescriptions for more than 22 pills saw a greater decrease than prescriptions for less than 21 days (37% vs 21%). However, the rate of decrease in opioid pills prescribed lessened from 14% in the first two years post implementation, to 10% in the third year. The decrease in partially filled opioid prescriptions for the first two years averaged 14% per year, while it increased by 23% in the third year. An 8% average decrease occurred in the rate of refills for opioid prescriptions for the first two years post implementation, followed by a 3% reduction in the third year. Conclusion: There was a 33% decrease in the overall quantity of opioid pills prescribed in the three years after the implementation of the PDMP. The first two years after implementation saw the largest decreases in prescribing habits, which slowed in the third year. More data are needed to show the long-term effects of implementing a statewide PDMP.
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Wang GS, Bajaj L, Poppy C, Valuck R. Integrated Prescription Drug Monitoring Program for Opioid Prescribing at a Children's Hospital. Clin Pediatr (Phila) 2022; 61:465-468. [PMID: 35442096 DOI: 10.1177/00099228221085344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- George Sam Wang
- Section of Emergency Medicine and Medical Toxicology, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Aurora, CO, USA
| | - Lalit Bajaj
- Section of Emergency Medicine and Medical Toxicology, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Aurora, CO, USA.,Department of Clinical Effectiveness, Children's Hospital Colorado, Aurora, CO, USA
| | - Christopher Poppy
- Clinical Application Services, Children's Hospital Colorado, Aurora, CO, USA
| | - Robert Valuck
- Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Witry M, Marie BS, Reist J. Provider perspectives and experiences following the integration of the prescription drug monitoring program into the electronic health record. Health Informatics J 2022; 28:14604582221113435. [PMID: 35829729 DOI: 10.1177/14604582221113435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Prescription drug monitoring programs (PDMPs) are a public health tool for prescribers and pharmacists to monitor controlled substance use at the patient level. The objectives of this study were to (1) assess attitudes about the PDMP and perceived changes in experience and decision-making following integration into the electronic health record (EHR), and (2) identify barriers to optimal PDMP use and user recommendations for improvement. This descriptive study used an electronic survey to obtain feedback from prescribers and pharmacists at a single academic medical center. Descriptive statistics were calculated, and textual data were analyzed. Of 1480 PDMP users 208 responded (14.1%). Responses demonstrated the integration of the PDMP into the EHR simplified log-in and access to PDMP information resulting in more frequent access and perceived improvement of care quality. Barriers included technical issues accessing the PDMP within the EHR and the lack of integration of other state PDMPs. Overall, the benefit of integrating the PDMP into the EHR was positive but largely limited to streamlining log-in and patient selection. Recommendations for improvement include addressing technological issues and education on PDMP interpretation and integrating new features that may modify prescribing, referral, and co-prescribing behaviors.
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Affiliation(s)
- Matthew Witry
- Pharmacy Practice and Science, 15509The University of Iowa College of Pharmacy, Iowa City, LA, USA
| | - Barbara St Marie
- College of Nursing, 16102The University of Iowa College of Nursing, Iowa City, LA, USA
| | - Jeffrey Reist
- Pharmacy Practice and Science, 15509The University of Iowa College of Pharmacy, Iowa City, LA, USA
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Lee VA, Compton WM, Pollock JD. Analysis of Access to Prescription Data Management Programs Data for Research. JAMA Netw Open 2022; 5:e2218094. [PMID: 35731519 PMCID: PMC9218843 DOI: 10.1001/jamanetworkopen.2022.18094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This cross-sectional study examines the availability of prescription drug monitoring program data for research and whether those data can be linked to other data.
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Affiliation(s)
- Vivian A. Lee
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
| | - Wilson M. Compton
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
| | - Jonathan D. Pollock
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
- Genetics, Epigenetics, and Developmental Neuroscience Branch, Division of Neuroscience and Behavior, National Institute on Drug Abuse, National Institutes of Health, Rockville, Maryland
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11
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Ellyson AM, Grooms J, Ortega A. Flipping the script: The effects of opioid prescription monitoring on specialty-specific provider behavior. HEALTH ECONOMICS 2022; 31:297-341. [PMID: 34773311 DOI: 10.1002/hec.4446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 08/20/2021] [Accepted: 10/05/2021] [Indexed: 06/13/2023]
Abstract
Mandatory access Prescription Drug Monitoring Programs (MA-PDMPs) aim to curb the epidemic at a common point of initiation of use, the prescription. However, there is recent concern about whether opioid policies have been too restrictive and reduced appropriate access to patients with the most need for opioid pharmaceuticals. We assess MA-PDMP's effect on specialty-specific opioid prescribing behavior of Medicare providers. Our findings suggest that requiring providers to query a PDMP differentially affects opioid prescribing across provider specialties. We find a three to four percent decrease in prescribing for Primary Care and Internal Medicine providers. This result is driven by healthcare providers at the lower end of the prescribing distribution. There is also suggestive evidence of an increase in opioid use disorder treatment drugs prescribed by these same providers. We also find no evidence for the hypothesis that MA-PDMPs restrict prescribing by providers who treat patients with potentially high levels of pain, few drug substitutes, or urgency for pain treatment (e.g., Oncology/Palliative care). This result is not dependent on whether a state provides exemptions for these providers. Our results indicate that MA-PDMPs may help close provider-patient informational gaps while retaining a provider's ability to supply these drugs to patients with a need for opioids.
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Affiliation(s)
- Alice M Ellyson
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle, Washington, USA
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Jevay Grooms
- Department of Economics, Howard University, Washington, District of Columbia, USA
| | - Alberto Ortega
- O'Neill School of Public and Environmental Affairs, Indiana University, Bloomington, Indiana, USA
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Hoppe D, Karimi L, Khalil H. Mapping the research addressing prescription drug monitoring programs: A scoping review. Drug Alcohol Rev 2022; 41:803-817. [PMID: 35106867 DOI: 10.1111/dar.13431] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 10/19/2021] [Accepted: 12/08/2021] [Indexed: 12/29/2022]
Abstract
ISSUES Prescription drug monitoring programs are a harm minimisation intervention and clinical decision support tool that address the public health concern surrounding prescription drug misuse. Given the large number of studies published to date and the ongoing implementation of these programs, it is important to map the literature and identify areas for further research to improve practice. APPROACH A scoping review was undertaken to identify the research on prescription drug monitoring programs published between January 2015 and April 2021. KEY FINDINGS A total of 153 citations were included in this scoping review. The majority of the studies originated from the USA and were quantitative. Results on program effectiveness are mixed and mainly examine their association with opioid-related outcomes. Unintended consequences are revealed in the literature and this review also highlights barriers to program use. IMPLICATIONS Overall, findings are mixed despite the large number of studies published to date. Mapping the literature identifies priority areas for further research that can advise policymakers and clinicians on practice improvement. CONCLUSION Results on prescription drug monitoring program effectiveness are mixed and mainly examine their association with opioid-related outcomes. This review highlights barriers to prescription drug monitoring program effectiveness related to program use and system integration. Further research is needed in these areas to improve prescription drug monitoring program use and patient outcomes.
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Affiliation(s)
- Dimi Hoppe
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Leila Karimi
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Hanan Khalil
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
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Turner HN, Oliver J, Compton P, Matteliano D, Sowicz TJ, Strobbe S, St Marie B, Wilson M. Pain Management and Risks Associated With Substance Use: Practice Recommendations. Pain Manag Nurs 2021; 23:91-108. [PMID: 34965906 DOI: 10.1016/j.pmn.2021.11.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 11/13/2021] [Indexed: 01/08/2023]
Abstract
Assessing and managing pain while evaluating risks associated with substance use and substance use disorders continues to be a challenge faced by health care clinicians. The American Society for Pain Management Nursing and the International Nurses Society on Addictions uphold the principle that all persons with co-occurring pain and substance use or substance use disorders have the right to be treated with dignity and respect, and receive evidence-based, high quality assessment, and management for both conditions. The American Society for Pain Management Nursing and International Nurses Society on Addictions have updated their 2012 position statement on this topic supporting an integrated, holistic, multidimensional approach, which includes nonopioid and nonpharmacological modalities. Opioid use disorder is used as an exemplar for substance use disorders and clinical recommendations are included with expanded attention to risk assessment and mitigation with interventions targeted to minimize the risk for relapse or escalation of substance use. Opioids should not be excluded for anyone when indicated for pain management. A team-based approach is critical, promotes the active involvement of the person with pain and their support systems, and includes pain and addiction specialists whenever possible. Health care systems should establish policies and procedures that facilitate and support the principles and recommendations put forth in this article.
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Affiliation(s)
| | - June Oliver
- Swedish Hospital, Northshore University Healthsystem, Chicago, IL.
| | | | | | | | | | - Barbara St Marie
- University of Iowa College of Nursing, Washington State University, College of Nursing
| | - Marian Wilson
- Oregon Health & Science University School of Nursing; Washington State University, College of Nursing
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Delcher C, Bae J, Wang Y, Doung M, Fink DS, Young HW. Defining "Doctor shopping" with Dispensing Data: A Scoping Review. PAIN MEDICINE 2021; 23:1323-1332. [PMID: 34931686 DOI: 10.1093/pm/pnab344] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 12/14/2021] [Accepted: 12/14/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND "Doctor shopping" typically refers to patients that seek controlled substance prescriptions from multiple providers with the presumed intent to obtain these medications for non-medical use and/or diversion. The purpose of this scoping review is to document and examine the criteria used to identify "doctor shopping" from dispensing data in the United States. METHODS A scoping review was conducted on "doctor shopping" or analogous terminology from January 1, 2000 through December 31, 2020 using the Web of Science Core Collection (7 citation indices). Our search was limited to U.S. only, English-language, peer-reviewed and U.S. federal government studies. Studies without explicit "doctor shopping" criteria were excluded. Key components of these criteria included the number of prescribers and dispensers, dispensing period, and drug class (e.g., opioids). RESULTS Of 9,845 records identified, 95 articles met the inclusion criteria and our pool of studies ranged from years 2003 to 2020. The most common threshold-based or count definition was [≥4 Prescribers (P) AND ≥4 Dispensers (D)] (n = 12). Thirty-three studies used a 365-day detection window. Opioids alone were studied most commonly (n = 69), followed by benzodiazepines and stimulants (n = 5 and n = 2, respectively). Only 39 (41%) studies provided specific drug lists with active ingredients. CONCLUSION Relatively simple P × D criteria for identifying "doctor shopping" are still the dominant paradigm with the need for on-going validation. The value of P × D criteria may change through time with more diverse methods applied to dispensing data emerging.
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Affiliation(s)
- Chris Delcher
- Institute for Pharmaceutical Outcomes & Policy (IPOP), Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, Kentucky, USA.,Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, Kentucky, USA
| | - Jungjun Bae
- Institute for Pharmaceutical Outcomes & Policy (IPOP), Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, Kentucky, USA.,Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, Kentucky, USA
| | - Yanning Wang
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Michelle Doung
- Department of Occupational Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
| | - David S Fink
- Division of Translational Epidemiology, New York State Psychiatric Institute, New York, New York, USA
| | - Henry W Young
- Department of Emergency Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA
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Henry SG, Shev AB, Crow D, Stewart SL, Wintemute GJ, Fenlon C, Wirtz SJ. Impacts of prescription drug monitoring program policy changes and county opioid safety coalitions on prescribing and overdose outcomes in California, 2015-2018. Prev Med 2021; 153:106861. [PMID: 34687731 DOI: 10.1016/j.ypmed.2021.106861] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 09/05/2021] [Accepted: 10/14/2021] [Indexed: 11/30/2022]
Abstract
In 2015, California received funding to implement the Prescription Drug Overdose Prevention Initiative, a 4-year program to reduce deaths involving prescription opioids by 1) leveraging improvements to California's prescription drug monitoring program (PDMP) (i.e., mandatory PDMP registration for prescribers and pharmacists), and 2) supporting county opioid safety coalitions. We used statewide data from 2011 to 2018 to evaluate the Initiative's impact on opioid prescribing and overdose rates. Prescribing data were obtained from California's PDMP; fatal and non-fatal overdose data were obtained from the California Department of Public Health. Outcomes were monthly opioid prescribing rates and opioid overdose rates, modeled using generalized linear mixed models. Exposures were mandatory PDMP registration, presence of county coalitions, and Initiative support for county coalitions. Mandatory PDMP registration was associated with a 25% decrease (95%CI, 0.71-0.79) in opioid prescribing rates after 24 months. Having a county coalition was associated with a 2% decrease (95%CI, 0.96-0.99) in the opioid prescribing rate; receiving Initiative support was associated with an additional 2% decrease (95%CI, 0.97-0.98). Mandatory PDMP registration and county coalitions were associated with a 35% decrease (95%CI, 0.43-0.97) and a 21% decrease (95% CI, 0.70-0.90), respectively in prescription opioid overdose deaths. Both interventions were also associated with significantly fewer deaths involving any opioid but had no significant association with non-fatal overdose rates. Findings add to the knowledge available to guide policy to prevent high-risk prescribing and opioid overdoses. While further study is needed, coalitions and mandatory PDMP registration may be important components in such efforts.
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Affiliation(s)
- Stephen G Henry
- Department of Internal Medicine, University of California Davis, 4150 V St Suite 2400, Sacramento, CA 95817, USA.
| | - Aaron B Shev
- Violence Prevention Research Program, University of California Davis, 2315 Stockton Blvd, Sacramento, CA 95817, USA
| | - David Crow
- Substance and Addiction Prevention Branch, California Department of Public Health, 1616 Capitol Ave MS 8701, Sacramento, CA 95814, USA
| | - Susan L Stewart
- Department of Public Health Sciences, University of California Davis, Medical Sciences 1-C, One Shields Ave, Davis, CA 95616, USA
| | - Garen J Wintemute
- Violence Prevention Research Program, University of California Davis, 2315 Stockton Blvd, Sacramento, CA 95817, USA
| | - Christine Fenlon
- Substance and Addiction Prevention Branch, California Department of Public Health, 1616 Capitol Ave MS 8701, Sacramento, CA 95814, USA
| | - Stephen J Wirtz
- Injury and Violence Prevention Branch, California Department of Public Health, 1616 Capitol Ave, Suite 74.436 MS 7214, Sacramento, CA 95814, USA
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16
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Picco L, Lam T, Haines S, Nielsen S. How prescription drug monitoring programs influence clinical decision-making: A mixed methods systematic review and meta-analysis. Drug Alcohol Depend 2021; 228:109090. [PMID: 34600255 DOI: 10.1016/j.drugalcdep.2021.109090] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/02/2021] [Accepted: 08/02/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Opioid prescribing, for chronic non-cancer pain, has increased substantially in the past two decades and is associated with significant harms. Various public health approaches have been adopted to address these harms including the implementation of prescription drug monitoring programs (PDMPs). This systematic review aims to identify how PDMP use influences healthcare providers' clinical decision-making. METHODS Six databases were searched for literature up until April 2021. Empirical studies were included, with no restrictions placed on year, location, language or study design. Thematic analysis of the identified articles was conducted and where possible, meta-analyses were conducted using a random effect model in Stata. RESULTS Forty-one articles related to 39 studies were included. All studies were conducted in the United States, published between 2005 and 2021 and most (n = 28) related to one state-level PDMP. PDMP utilisation influenced healthcare providers' clinical decision-making across seven broad themes: (i) the supply of controlled substances, (ii) refusal to prescribe or treat, (iii) risk mitigation strategies, (iv) communication, (v) education and counselling, (vi) referrals and care coordination and (vii) stigma. CONCLUSIONS PDMP use influenced healthcare providers' clinical decision-making, resulting in both intended and unintended outcomes for patients. PDMPs are a public health initiative designed to reduce harms associated with increased opioid prescribing, yet their use is associated with multiple unintended outcomes. Targeted research is needed to understand the impact of healthcare providers' clinical decision-making after PDMP utilisation, and the clinical outcomes for patients identified through these tools.
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Affiliation(s)
- Louisa Picco
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston 3199, Victoria, Australia.
| | - Tina Lam
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston 3199, Victoria, Australia.
| | - Sarah Haines
- Turner Institute for Brain and Mental Health, Monash University, Clayton 3800, Victoria, Australia.
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston 3199, Victoria, Australia.
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Robinson A, Wilson MN, Hayden JA, Rhodes E, Campbell S, MacDougall P, Asbridge M. Health Care Provider Utilization of Prescription Monitoring Programs: A Systematic Review and Meta-Analysis. PAIN MEDICINE (MALDEN, MASS.) 2021; 22:1570-1582. [PMID: 33484144 PMCID: PMC8311582 DOI: 10.1093/pm/pnaa412] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To synthesize the literature on the proportion of health care providers who access and use prescription monitoring program data in their practice, as well as associated barriers to the use of such data. DESIGN We performed a systematic review using a standard systematic review method with meta-analysis and qualitative meta-summary. We included full-published peer-reviewed reports of study data, as well as theses and dissertations. METHODS We identified relevant quantitative and qualitative studies. We synthesized outcomes related to prescription monitoring program data use (i.e., ever used, frequency of use). We pooled the proportion of health care providers who had ever used prescription monitoring program data by using random effects models, and we used meta-summary methodology to identify prescription monitoring program use barriers. RESULTS Fifty-three studies were included in our review, all from the United States. Of these, 46 reported on prescription monitoring program use and 32 reported on barriers. The pooled proportion of health care providers who had ever used prescription monitoring program data was 0.57 (95% confidence interval: 0.48-0.66). Common barriers to prescription monitoring program data use included time constraints and administrative burdens, low perceived value of prescription monitoring program data, and problems with prescription monitoring program system usability. CONCLUSIONS Our study found that health care providers underutilize prescription monitoring program data and that many barriers exist to prescription monitoring program data use.
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Affiliation(s)
- Alysia Robinson
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Maria N Wilson
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jill A Hayden
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Emily Rhodes
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Samuel Campbell
- Department of Emergency Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Peter MacDougall
- Department of Emergency Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Anesthesiology, Pain Management and Peri-Operative Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Mark Asbridge
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Emergency Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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Abstract
OBJECTIVES To determine the association between self-reported heroin initiation and patterns of prescription opioid use. METHODS Using linked Oregon Medicaid, prescription drug monitoring program, and Treatment Episodes Data Set data, we conducted a case-control study of individuals reporting heroin initiation between 2015 and 2017 during treatment intake. Prescription drug monitoring program data provided prescription opioid use patterns, including long-term prescription opioid therapy, in the year before self-reported heroin initiation. Four controls were matched to each case on aggregate prescription opioid use and demographics. RESULTS About half (49%) of individuals who reported heroin initiation filled an opioid in the year before initiation. Individuals who initiated heroin (n = 306) were more likely to receive prescriptions from multiple prescribers (24% vs 18%, P = 0.007) and pharmacies (12% vs 5%, P < 0.001) compared with matched controls (n = 1224). Long-term opioid therapy (13% vs 14%, P = 0.74) was uncommon and did not differ between groups. CONCLUSIONS Although prescription opioid use commonly preceded self-reported heroin initiation, long-term opioid therapy was not common. Although this study did not find an association between opioid discontinuation and heroin initiation, sample size and follow-up limitations preclude definitive conclusions. Efforts to limit prescription opioids should continue to evaluate for unintended harms.
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Delcher C, Harris DR, Park C, Strickler G, Talbert J, Freeman PR. "Doctor and pharmacy shopping": A fading signal for prescription opioid use monitoring? Drug Alcohol Depend 2021; 221:108618. [PMID: 33677354 PMCID: PMC8026641 DOI: 10.1016/j.drugalcdep.2021.108618] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/26/2021] [Accepted: 01/26/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND The term "doctor and pharmacy shopping" colloquially describes patients with high multiple provider episodes (MPEs)-a threshold count of distinct prescribers and/or pharmacies involved in prescription fulfillment. Opioid-related MPEs are implicated in the global opioid crisis and heavily monitored by government databases such as U.S. state prescription drug monitoring programs (PDMPs). We applied a widely-used MPE definition to examine U.S. trends from a large, commercially-insured population from 2010 to 2017. Further, we examined the proportion of enrollees identified as "doctor shoppers" with evidence of a cancer diagnosis to examine the risk of false positives. METHODS Using a large, commercially-insured population, we identified patients with opioid-related MPEs: opioid prescriptions (Schedule II-V, no buprenorphine) filled from ≥5 prescribers AND ≥ 5 pharmacies within the past 90 days ("5x5x90d"). Quarterly rates per 100,000 enrollees (two specifications) were calculated between 2010 and 2017. We examined the trend in a recently published all-payer, 7 state cohort from the U.S. Centers for Disease Control and Prevention for comparison. Cancer-related ICD-9/10-CM codes were used. RESULTS Quarterly MPE rates declined by approximately 73 % from 18.2-4.9 per 100,000 enrollee population with controlled substance prescriptions. In 2017, nearly one fifth of these commercially-insured enrollees identified by the 5x5x90d algorithm were diagnosed with cancer. Approximately 8% of this sample included patients with ≥ 1 buprenorphine prescriptions. CONCLUSIONS Opioid "shopping" flags are a long-standing but rapidly fading PDMP signal. To avoid unintended consequences, such as identifying legitimate medical encounters requiring high healthcare utilization or opioid treatment, while maintaining vigilance, more nuanced and sophisticated approaches are needed.
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Affiliation(s)
- Chris Delcher
- Institute for Pharmaceutical Outcomes and Policy, University of Kentucky, 760 Press Avenue, Research Building 2, Ste 260, Lexington, KY, 40536-0679, United States; Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, 760 Press Avenue, Research Building 2, Ste 260, Lexington, KY, 40536-0679, United States.
| | - Daniel R. Harris
- Institute for Pharmaceutical Outcomes and Policy, University of Kentucky, 760 Press Avenue, Research Building 2, Ste 260 Lexington, KY 40536-0679,Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, 760 Press Avenue, Research Building 2, Ste 260 Lexington, KY 40536-0679
| | - Changwe Park
- Institute for Pharmaceutical Outcomes and Policy, University of Kentucky, 760 Press Avenue, Research Building 2, Ste 260 Lexington, KY 40536-0679,Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, 760 Press Avenue, Research Building 2, Ste 260 Lexington, KY 40536-0679
| | - Gail Strickler
- Schneider Institutes for Health Policy, Brandeis University, 415 South Street Waltham, MA 02454-9110
| | - Jeffery Talbert
- Institute for Biomedical Informatics, College of Medicine, University of Kentucky, 267 Healthy Kentucky Research Building 760 Press Ave Lexington, KY 40536
| | - Patricia R. Freeman
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, 760 Press Avenue, Research Building 2, Ste 260 Lexington, KY 40536-0679
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20
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Martin HD, Modi SS, Feldman SS. Barriers and facilitators to PDMP IS Success in the US: A systematic review. Drug Alcohol Depend 2021; 219:108460. [PMID: 33387937 DOI: 10.1016/j.drugalcdep.2020.108460] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/15/2020] [Accepted: 11/17/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Prescription Drug Monitoring Programs (PDMP) help prevent prescription drug misuse and promote appropriate pain management. Despite these benefits and PDMP mandates in most states, PDMPs face challenges that hinder their success. This paper uses the Delone and McLean Information Success (IS) Model to review the current literature for barriers and facilitators to PDMP quality, use, intention to use and user satisfaction in the United States (U.S.). MATERIAL AND METHODS Scopus, PubMed and Embase databases were searched due to their relevance to information technology, education and research. RESULTS There were 142 and 183 barriers and facilitators, respectively, found in 44 peer reviewed articles. Barriers to PDMP quality, use and user satisfaction include lack of interstate data sharing, access difficulties, lack of time, inability to delegate access, lack of knowledge or awareness of the PMDP, and lack of EHR integration. Facilitators to PDMP quality, use and user satisfaction include interstate data connections, real-time data updates, EHR integration, and access delegation. DISCUSSION Interstate data sharing, EHR integration and expanding access to delegates were common themes found. Some results were found to be contradictory such as mandating use. CONCLUSION PDMP users can use these findings to assess current barriers to PDMP success in the U.S. and draw possible solutions from the list of facilitators. Practitioners should consider the context of their state and organization when determining which facilitators would most promote PDMP IS success. Combining facilitators may be the best route to PDMP IS success in certain situations.
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Affiliation(s)
- Heather D Martin
- School of Health Professions, The University of Alabama at Birmingham, 1716 9th Ave S, Birmingham, AL, 35233, United States.
| | - Shikha S Modi
- School of Health Professions, The University of Alabama at Birmingham, 1716 9th Ave S, Birmingham, AL, 35233, United States
| | - Sue S Feldman
- School of Health Professions, The University of Alabama at Birmingham, 1716 9th Ave S, Birmingham, AL, 35233, United States
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21
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Castillo-Carniglia A, González-Santa Cruz A, Cerdá M, Delcher C, Shev AB, Wintemute GJ, Henry SG. Changes in opioid prescribing after implementation of mandatory registration and proactive reports within California's prescription drug monitoring program. Drug Alcohol Depend 2021; 218:108405. [PMID: 33234299 PMCID: PMC7750250 DOI: 10.1016/j.drugalcdep.2020.108405] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/26/2020] [Accepted: 10/27/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND In 2016, California updated its prescription drug monitoring program (PDMP), adding two key features: automated proactive reports to prescribers and mandatory registration for prescribers and pharmacists. The effects of these changes on prescribing patterns have not yet been examined. We aimed to evaluate the joint effect of these two PDMP features on county-level prescribing practices in California. METHODS Using county-level quarterly data from 2012 to 2017, we estimated the absolute change associated with the implementation of these two PDMP features in seven prescribing indicators in California versus a control group comprising counties in Florida and Washington: opioid prescription rate per 1000 residents; patients' mean daily opioid dosage in milligrams of morphine equivalents[MME]; prescribers' mean daily MME prescribed; prescribers' mean number of opioid prescriptions per day; percentage of patients getting >90 MME/day; percentage of days with overlapping prescriptions for opioids and benzodiazepines; multiple opioid provider episodes per 100,000 residents. RESULTS Proactive reports and mandatory registration were associated with a 7.7 MME decrease in patients' mean daily opioid dose (95 %CI: -11.4, -2.9); a 1.8 decrease in the percentage of patients prescribed high-dose opioids (95 %CI: -2.3, -0.9); and a 6.3 MME decrease in prescribers' mean daily dose prescribed (95 %CI: -10.0, -1.3). CONCLUSIONS California's implementation of these two PDMP features was associated with decreases in the total quantity of opioid MMEs prescribed, and indicators of patients prescribed high-dose opioids compared to states that had PDMP's without these features. Rates of opioid prescribing and other high-risk prescribing patterns remained unchanged.
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Affiliation(s)
- Alvaro Castillo-Carniglia
- Society and Health Research Center, Universidad Mayor, Chile; School of Public Health, Universidad Mayor, Chile; Department of Population Health, New York University, United States.
| | | | - Magdalena Cerdá
- Department of Population Health, New York University, United States
| | - Chris Delcher
- Department of Pharmacy Practice and Science, University of Kentucky, United States
| | - Aaron B Shev
- Violence Prevention Research Program, University of California, Davis, United States
| | - Garen J Wintemute
- Violence Prevention Research Program, University of California, Davis, United States
| | - Stephen G Henry
- Department of Internal Medicine, University of California, Davis, United States; Center for Healthcare Policy and Research, University of California, Davis, United States
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22
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Hartung DM, Johnston KA, Hallvik S, Leichtling G, Geddes J, Hildebran C, Keast S, Chan B, Korthuis PT. Prescription Opioid Dispensing Patterns Prior to Heroin Overdose in a State Medicaid Program: a Case-Control Study. J Gen Intern Med 2020; 35:3188-3196. [PMID: 32935311 PMCID: PMC7661590 DOI: 10.1007/s11606-020-06192-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 08/27/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND A large proportion of individuals who use heroin report initiating opioid use with prescription opioids. However, patterns of prescription opioid use preceding heroin-related overdose have not been described. OBJECTIVE To describe prescription opioid use in the year preceding heroin overdose. DESIGN Case-control study comparing prescription opioid use with a heroin-involved overdose, non-heroin-involved opioid overdose, and non-overdose controls from 2015 to 2017. PARTICIPANTS Oregon Medicaid beneficiaries with linked administrative claims, vital statistics, and prescription drug monitoring program data. MAIN MEASURES Opioid, benzodiazepine, and other central nervous system depressant prescriptions preceding overdose; among individuals with one or more opioid prescription, we assessed morphine milligram equivalents per day, overlapping prescriptions, prescriptions from multiple prescribers, long-term use, and discontinuation of long-term use. KEY RESULTS We identified 1458 heroin-involved overdoses (191 fatal) and 2050 non-heroin-involved opioid overdoses (266 fatal). In the 365 days prior to their overdose, 45% of individuals with a heroin-involved overdose received at least one prescribed opioid compared with 78% of individuals who experienced a non-heroin-involved opioid overdose (p < 0.001). For both heroin- and non-heroin-involved overdose cases, the likelihood of receiving an opioid increased with age. Among heroin overdose cases with an opioid dispensed, the rate of multiple pharmacy use was the only high-risk opioid pattern that was greater than non-overdose controls (adjusted odds ratio 3.2; 95% confidence interval 1.48 to 6.95). Discontinuation of long-term opioid use was not common prior to heroin overdose and not higher than discontinuation rates among non-overdose controls. CONCLUSIONS Although individuals with a heroin-involved overdose were less likely to receive prescribed opioids in the year preceding their overdose relative to non-heroin opioid overdose cases, prescription opioid use was relatively common and increased with age. Discontinuation of long-term prescription opioid use was not associated with heroin-involved overdose.
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Affiliation(s)
- Daniel M Hartung
- College of Pharmacy, Oregon State University, , Portland, OR, USA.
| | | | | | | | - Jonah Geddes
- College of Pharmacy, Oregon State University, , Portland, OR, USA
| | | | - Shellie Keast
- University of Oklahoma College of Pharmacy, , Oklahoma City, OK, USA
| | - Brian Chan
- Oregon Health & Science University, , Portland, OR, USA
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23
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Sears JM, Haight JR, Fulton-Kehoe D, Wickizer TM, Mai J, Franklin GM. Changes in early high-risk opioid prescribing practices after policy interventions in Washington State. Health Serv Res 2020; 56:49-60. [PMID: 33011988 PMCID: PMC7839645 DOI: 10.1111/1475-6773.13564] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To test associations between several opioid prescribing policy interventions and changes in early (acute/subacute) high-risk opioid prescribing practices. DATA SOURCES Population-based workers' compensation pharmacy billing and claims data, Washington State Department of Labor and Industries (January 2008-June 2015). STUDY DESIGN We used interrupted time series analysis to test associations between three policy intervention timepoints and monthly proportions of population-based measures of high-risk, low-risk, and any workers' compensation-related opioid prescribing. We also tested associations between the policy intervention timepoints and five high-risk opioid prescribing indicators among workers prescribed any opioids within 3 months after injury: (a) >7 cumulative (not necessarily consecutive) days' supply of opioids during the acute phase, (b) high-dose opioids, (c) concurrent sedatives, (d) chronic opioids, and (e) a composite high-risk opioid prescribing indicator. PRINCIPAL FINDINGS Within 3 months after injury, 9 percent of workers were exposed to high-risk and 12 percent to low-risk workers' compensation-related opioid prescribing; 79 percent filled no workers' compensation-related opioid prescription. Among workers prescribed any early (acute/subacute) opioids, the indicator for >7 days' supply of opioids during the acute phase was present for 30 percent, high-dose opioids for 18 percent, concurrent sedatives for 3 percent, and chronic opioids for 2 percent. Beyond a general shift toward more infrequent and lower-risk workers' compensation-related opioid prescribing, each policy intervention timepoint was significantly associated with reductions in specific acute/subacute high-risk opioid prescribing indicators; each of the four specific high-risk opioid prescribing indicators had significant reductions associated with at least one policy. CONCLUSIONS Several state-level opioid prescribing policies were significantly associated with safer workers' compensation-related opioid prescribing practices during the first 3 months after injury (acute/subacute phase), which should in turn reduce transition to chronic opioids and associated negative health outcomes.
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Affiliation(s)
- Jeanne M Sears
- Department of Health Services, University of Washington, Seattle, Washington, USA.,Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington, USA.,Harborview Injury Prevention and Research Center, Seattle, Washington, USA.,Institute for Work and Health, Toronto, Ontario, Canada
| | - John R Haight
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington, USA.,Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Deborah Fulton-Kehoe
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington, USA
| | - Thomas M Wickizer
- Division of Health Services Management and Policy, The Ohio State University College of Public Health, Columbus, Ohio, USA
| | - Jaymie Mai
- Washington State Department of Labor and Industries, Tumwater, Washington, USA
| | - Gary M Franklin
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington, USA.,Washington State Department of Labor and Industries, Tumwater, Washington, USA.,Department of Neurology, University of Washington, Seattle, Washington, USA
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24
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Ansari B, Tote KM, Rosenberg ES, Martin EG. A Rapid Review of the Impact of Systems-Level Policies and Interventions on Population-Level Outcomes Related to the Opioid Epidemic, United States and Canada, 2014-2018. Public Health Rep 2020; 135:100S-127S. [PMID: 32735190 PMCID: PMC7407056 DOI: 10.1177/0033354920922975] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES In the United States, rising rates of overdose deaths and recent outbreaks of hepatitis C virus and HIV infection are associated with injection drug use. We updated a 2014 review of systems-level opioid policy interventions by focusing on evidence published during 2014-2018 and new and expanded opioid policies. METHODS We searched the MEDLINE database, consistent with the 2014 review. We included articles that provided original empirical evidence on the effects of systems-level interventions on opioid use, overdose, or death; were from the United States or Canada; had a clear comparison group; and were published from January 1, 2014, through July 19, 2018. Two raters screened articles and extracted full-text data for qualitative synthesis of consistent or contradictory findings across studies. Given the rapidly evolving field, the review was supplemented with a search of additional articles through November 17, 2019, to assess consistency of more recent findings. RESULTS The keyword search yielded 535 studies, 66 of which met inclusion criteria. The most studied interventions were prescription drug monitoring programs (PDMPs) (59.1%), and the least studied interventions were clinical guideline changes (7.6%). The most common outcome was opioid use (77.3%). Few articles evaluated combination interventions (18.2%). Study findings included the following: PDMP effectiveness depends on policy design, with robust PDMPs needed for impact; health insurer and pharmacy benefit management strategies, pill-mill laws, pain clinic regulations, and patient/health care provider educational interventions reduced inappropriate prescribing; and marijuana laws led to a decrease in adverse opioid-related outcomes. Naloxone distribution programs were understudied, and evidence of their effectiveness was mixed. In the evidence published after our search's 4-year window, findings on opioid guidelines and education were consistent and findings for other policies differed. CONCLUSIONS Although robust PDMPs and marijuana laws are promising, they do not target all outcomes, and multipronged interventions are needed. Future research should address marijuana laws, harm-reduction interventions, health insurer policies, patient/health care provider education, and the effects of simultaneous interventions on opioid-related outcomes.
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Affiliation(s)
- Bahareh Ansari
- Department of Information Science, University at Albany–State University of New York, Albany, NY, USA
| | - Katherine M. Tote
- Department of Epidemiology and Biostatistics, University at Albany–State University of New York, Albany, NY, USA
- Center for Collaborative HIV Research in Practice and Policy, Albany, NY, USA
| | - Eli S. Rosenberg
- Department of Epidemiology and Biostatistics, University at Albany–State University of New York, Albany, NY, USA
- Center for Collaborative HIV Research in Practice and Policy, Albany, NY, USA
| | - Erika G. Martin
- Center for Collaborative HIV Research in Practice and Policy, Albany, NY, USA
- Department of Public Administration and Policy, University at Albany–State University of New York, Albany, NY, USA
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Ibrahimi SE, Hallvik S, Johnston K, Leichtling G, Choo E, Hartung DM. A comparison of trends in opioid dispensing patterns between Medicaid pharmacy claims and prescription drug monitoring program data. Pharmacoepidemiol Drug Saf 2020; 29:1168-1174. [PMID: 32939909 PMCID: PMC8015255 DOI: 10.1002/pds.5097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/29/2020] [Accepted: 07/19/2020] [Indexed: 11/06/2022]
Abstract
PURPOSE Public and private payers have implemented benefit limitations to reduce high-risk opioid prescriptions. The effect of these policies on the increase of out-pocket payment is unclear. To understand this gap, we compared the discrepancies in trends between opioid prescription fills vs claims among Medicaid beneficiaries. METHODS Data from the Oregon Prescription Drug Monitoring Program (PDMP) and Oregon Medicaid administrative claims were used to identify Medicaid beneficiaries 18 years and older enrolled at least one full month from 2015 to 2017. Generalized linear models assessed the trends in the monthly rates of opioid PDMP prescription fills and pharmacy claims per 1000 eligible members. Rates by morphine equivalent dose (MED) tier (<50, 50-89, 90-120, >120 MED) and co-prescribed opioid and benzodiazepine were also assessed. RESULTS During the study period, an average of 495 355 Medicaid members had 2 797 054 opioid PDMP fills and 2 472 155 opioid Medicaid pharmacy claims. Study participants had 15.4 (95% confidence interval [CI] 13.6 to 17.0; P < .001) more prescriptions per 1000 member per month in the PDMP data (114.1 [SD 7.4]) compared with the Medicaid claims data (98.7 [SD 7.9]). Similarly, there were 1.9 more co-occurring opioid/benzodiazepine prescriptions per 1000 members per month observed in the PDMP data than the Medicaid claims data (95% CI 1.7 to 2.1; P < .001). At each MED tier, the PDMP fills were consistently higher than the claims (P < .001). CONCLUSIONS Higher rate of fills in the PDMP compared to pharmacy claims suggests that there may be an increasing trend of out-of-pocket payment among Medicaid beneficiaries.
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Affiliation(s)
- Sanae El Ibrahimi
- Department of Research and Evaluation, Comagine Health, Portland, Oregon
- Department of Epidemiology and Biostatistics, School of Public Health, University of Nevada, Las Vegas, Nevada
| | - Sara Hallvik
- Department of Research and Evaluation, Comagine Health, Portland, Oregon
| | - Kirbee Johnston
- College of Pharmacy, Oregon State University, Corvallis, Oregon
| | - Gillian Leichtling
- Department of Research and Evaluation, Comagine Health, Portland, Oregon
| | - Esther Choo
- Center for Policy and Research in Emergency Medicine, Oregon Health & Science University, Portland, Oregon
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A Time-Series Analysis of the Association Between Occupational Health Policies and Opioid Prescription Patterns in United States Active Duty Military Service Members From 2006 to 2018. J Occup Environ Med 2020; 62:e295-e301. [PMID: 32730032 DOI: 10.1097/jom.0000000000001872] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The Department of Defense (DoD) implemented numerous occupational health policies to guide opioid prescribing to active duty military service members (ADSM). This retrospective time series analysis evaluated the impact of DoD policies on opioid prescribing trends in ADSM from 2006 to 2018. METHODS Bayesian structural time-series models with a Markov chain Monte Carlo algorithm for posterior inference and a semi-local linear trend were constructed to estimate the impact of polices. RESULTS Results indicate annual opioid proportions significantly decreased after the introduction of occupational health policies introduced in 2011 to 2012. Collectively, occupational policies were associated with a significant reduction (6.6%) in annual opioid rates to ADSM following 2012. This observed effect was associated with approximately 121,000 less opioid prescriptions dispensed in 2018 alone. CONCLUSIONS Occupational health policy interventions were associated with reductions in opioid prescribing within the DoD.
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Duppong T, Amato A, Silverman M, Eskin B, Allegra JR. Emergency department opioid prescriptions decreased after legislation in New Jersey. Am J Emerg Med 2020; 38:1134-1136. [DOI: 10.1016/j.ajem.2019.158394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 08/03/2019] [Accepted: 08/13/2019] [Indexed: 11/30/2022] Open
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Madras BK, Ahmad NJ, Wen J, Sharfstein JS. Improving Access to Evidence-Based Medical Treatment for Opioid Use Disorder: Strategies to Address Key Barriers within the Treatment System. NAM Perspect 2020; 2020:202004b. [PMID: 35291732 PMCID: PMC8916813 DOI: 10.31478/202004b] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Even though evidence-based treatment for opioid use disorders (OUD) is effective, almost four in five Americans with OUD do not receive any form of treatment. The gap in access to evidence-based care, including treatment with medications for OUD, stems in part from barriers to change within the health care system. This paper includes nine key barriers that prevent access to evidence-based care, including stigma; inadequate clinical training; a dearth of addiction specialists; lack of integration of MOUD provision in practice; regulatory, statutory, and data sharing restrictions; and financial barriers. Action from a number of actors is urgently needed to address this crisis.
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Affiliation(s)
| | - N Jia Ahmad
- Johns Hopkins Bloomberg School of Public Health
| | - Jenny Wen
- Johns Hopkins University School of Medicine
| | - Joshua Sharfstein Sharfstein
- Johns Hopkins Bloomberg School of Public Health; and the Prevention, Treatment, and Recovery Working Group of the Action Collaborative on Countering the U.S. Opioid Epidemic
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Puac-Polanco V, Chihuri S, Fink DS, Cerdá M, Keyes KM, Li G. Prescription Drug Monitoring Programs and Prescription Opioid-Related Outcomes in the United States. Epidemiol Rev 2020; 42:134-153. [PMID: 32242239 DOI: 10.1093/epirev/mxaa002] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 03/24/2020] [Accepted: 03/25/2020] [Indexed: 11/14/2022] Open
Abstract
Prescription drug monitoring programs (PDMPs) are a crucial component of federal and state governments' response to the opioid epidemic. Evidence about the effectiveness of PDMPs in reducing prescription opioid-related adverse outcomes is mixed. We conducted a systematic review to examine whether PDMP implementation within the United States is associated with changes in 4 prescription opioid-related outcome domains: opioid prescribing behaviors, opioid diversion and supply, opioid-related morbidity and substance-use disorders, and opioid-related deaths. We searched for eligible publications in Embase, Google Scholar, MEDLINE, and Web of Science. A total of 29 studies, published between 2009 and 2019, met the inclusion criteria. Of the 16 studies examining PDMPs and prescribing behaviors, 11 found that implementing PDMPs reduced prescribing behaviors. All 3 studies on opioid diversion and supply reported reductions in the examined outcomes. In the opioid-related morbidity and substance-use disorders domain, 7 of 8 studies found associations with prescription opioid-related outcomes. Four of 8 studies in the opioid-related deaths domain reported reduced mortality rates. Despite the mixed findings, emerging evidence supports that the implementation of state PDMPs reduces opioid prescriptions, opioid diversion and supply, and opioid-related morbidity and substance-use disorder outcomes. When PDMP characteristics were examined, mandatory access provisions were associated with reductions in prescribing behaviors, diversion outcomes, hospital admissions, substance-use disorders, and mortality rates. Inconsistencies in the evidence base across outcome domains are due to analytical approaches across studies and, to some extent, heterogeneities in PDMP policies implemented across states and over time.
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Affiliation(s)
- Victor Puac-Polanco
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
| | - Stanford Chihuri
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York.,Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - David S Fink
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
| | - Magdalena Cerdá
- Department of Population Health, New York University Grossman School of Medicine, New York, New York
| | - Katherine M Keyes
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
| | - Guohua Li
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York.,Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
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Leichtling G, Hildebran C, Novak K, Alley L, Doyle S, Reilly C, Weiner SG. Physician Responses to Enhanced Prescription Drug Monitoring Program Profiles. PAIN MEDICINE 2020; 21:e9-e21. [PMID: 30698811 DOI: 10.1093/pm/pny291] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Many states have begun implementing enhancements to PDMP patient profiles such as summaries or graphics to highlight issues of concern and enhance comprehension. The purpose of this study was to examine how physicians respond to sample enhanced PDMP profiles based on patient vignettes. DESIGN Brief semistructured interviews with physicians. SETTING Three national medical conferences for targeted specialties. SUBJECTS Ninety-three physicians practicing in primary care, emergency medicine, or pain management. METHODS We presented participants with one of three patient vignettes with corresponding standard and enhanced PDMP profiles and conducted brief interviews. RESULTS Findings indicated that enhanced profiles could increase ease of comprehension, reduce time burden, and aid in communicating with patients about opioid risks. Physicians also expressed concern about liability for prescribing when the enhanced profile indicates risk and cautioned against any implication that risk warnings should override clinical judgment based on the patient's complete medical history or presenting condition. Physicians emphasized the need for transparency of measures and evidence of validation of risk scores. We found little indication that enhanced profiles would change opioid prescribing decisions, though decisions varied by physician. CONCLUSIONS Our study underscores the importance of involving prescribers in developing and testing PDMP profile enhancements, as well as providing guidance in the interpretation and clinical use of enhanced profiles. Reduced time burden is an important benefit to consider as the number of states mandating PDMP use increases.
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Affiliation(s)
| | | | | | | | - Sheri Doyle
- The Pew Charitable Trust Substance Use Prevention and Treatment Initiative, Washington DC, USA
| | | | - Scott G Weiner
- Brigham and Women's Hospital, Division of Health Policy Research Translation, Department of Emergency Medicine, Boston, MA.,Harvard Medical School, Department of Emergency Medicine, Boston, MA
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Pain management and prescribing practices in otolaryngology residency programs. Am J Otolaryngol 2020; 41:102265. [PMID: 31387767 DOI: 10.1016/j.amjoto.2019.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 07/15/2019] [Indexed: 11/20/2022]
Abstract
PURPOSE To understand the knowledge, competency and influencing factors regarding postoperative opioid prescribing practices among Otolaryngology Residents. To understand the educational background and resources regarding pain management and opioid prescribing among Otolaryngology Residency Programs. MATERIALS AND METHODS An anonymous electronic survey was distributed to Otolaryngology residents in the greater New York City area. Subjects reported their preferred pain management prescription for eight common otolaryngology surgeries. Questions addressed opioid and non-opioid prescribing influences, use/knowledge of pain management resources, and prior opioid prescribing education (OPE). An anonymous survey was distributed to US Otolaryngology Program Directors addressing resident prescribing influences and OPE in residency training programs. RESULTS Thirty-Five residents and fifteen PDs participated. Resident opioid prescribing was widely variable with averages ranging from 3.8 to 21.1 narcotic pills among eight standard otolaryngology surgeries. Attending/senior preference was believed to largely influence resident prescribing habits among residents (3.66, ±6.68), and PDs (4.73, ±0.46). Only 20% of programs had formal OPE in place, consistent with the 65.71% of residents who reported no prior OPE. CONCLUSIONS AND RELEVANCE A large inconsistency in Otolaryngology resident postoperative pain management exists, despite their responsibility to provide analgesic therapy. The lack of formal OPE programs in US Otolaryngology residency programs may lead to outside factors unrelated to surgery influencing these prescribing practices. This brings light to the need of Otolaryngology Resident OPE to assist in standardizing prescribing practices, provide meaningful patient education on opioid use and disposal and educate residents on the risk assessment tools offered to provide the most appropriate and safe analgesic therapy to patients.
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Nechuta S, Mukhopadhyay S, Krishnaswami S, Golladay M, McPheeters M. Record Linkage Approaches Using Prescription Drug Monitoring Program and Mortality Data for Public Health Analyses and Epidemiologic Studies. Epidemiology 2020; 31:22-31. [PMID: 31592867 PMCID: PMC6889900 DOI: 10.1097/ede.0000000000001110] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 09/25/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND The use of Prescription Drug Monitoring Program (PDMP) data has greatly increased in recent years as these data have accumulated as part of the response to the opioid epidemic in the United States. We evaluated the accuracy of record linkage approaches using the Controlled Substance Monitoring Database (Tennessee's [TN] PDMP, 2012-2016) and mortality data on all drug overdose decedents in Tennessee (2013-2016). METHODS We compared total, missed, and false positive (FP) matches (with manual verification of all FPs) across approaches that included a variety of data cleaning and matching methods (probabilistic/fuzzy vs. deterministic) for patient and death linkages, and prescription history. We evaluated the influence of linkage approaches on key prescription measures used in public health analyses. We evaluated characteristics (e.g., age, education, sex) of missed matches and incorrect matches to consider potential bias. RESULTS The most accurate probabilistic/fuzzy matching approach identified 4,714 overdose deaths (vs. the deterministic approach, n = 4,572), with a low FP linkage error (<1%) and high correct match proportion (95% vs. 92% and ~90% for probabilistic approaches not using comprehensive data cleaning). Estimation of all prescription measures improved (vs. deterministic approach). For example, frequency (%) of decedents filling an oxycodone prescription in the last 60 days (n = 1,371 [32%] vs. n = 1,443 [33%]). Missed overdose decedents were more likely to be younger, male, nonwhite, and of higher education. CONCLUSION Implications of study findings include underreporting, prescribing and outcome misclassification, and reduced generalizability to population risk groups, information of importance to epidemiologists and researchers using PDMP data.
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Affiliation(s)
- Sarah Nechuta
- From the Tennessee Department of Health, Office of Informatics and Analytics, 710 James Robertson Parkway, Nashville, TN
| | - Sutapa Mukhopadhyay
- From the Tennessee Department of Health, Office of Informatics and Analytics, 710 James Robertson Parkway, Nashville, TN
| | - Shanthi Krishnaswami
- From the Tennessee Department of Health, Office of Informatics and Analytics, 710 James Robertson Parkway, Nashville, TN
| | - Molly Golladay
- From the Tennessee Department of Health, Office of Informatics and Analytics, 710 James Robertson Parkway, Nashville, TN
| | - Melissa McPheeters
- From the Tennessee Department of Health, Office of Informatics and Analytics, 710 James Robertson Parkway, Nashville, TN
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Oldenhof E, Anderson-Wurf J, Hall K, Staiger PK. Beyond Prescriptions Monitoring Programs: The Importance of Having the Conversation about Benzodiazepine Use. J Clin Med 2019; 8:E2143. [PMID: 31817181 PMCID: PMC6947397 DOI: 10.3390/jcm8122143] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 11/29/2019] [Accepted: 12/02/2019] [Indexed: 12/19/2022] Open
Abstract
: Internationally there is an escalation of prescription-related overdose deaths, particularly related to benzodiazepine use. As a result, many countries have implemented prescription monitoring programs (PMPs) to increase the regulation of benzodiazepine medications. PMPs centralize prescription data for prescribers and pharmacists and generate alerts to high-doses, risky combinations, or multiple prescribers with the aim to reduce inappropriate prescribing and subsequently the potential of patient harm. However, it has become clear that prescribers have been provided with minimal guidance and insufficient training to effectively integrate PMP information into their decision making around prescribing these medications. Accordingly, this paper discusses how PMPs have given rise to a range of unintended consequences in those who have been prescribed benzodiazepines (BDZs). Given that a gradual taper is generally required to mitigate withdrawal from BDZs, there are concerns that alerts from PMPs have resulted in BDZs being ceased abruptly, resulting in a range of unintended harms to patients. It is argued that best practice guidelines based upon a patient-centered framework of decision-making, need to be developed and implemented, in order to curtail the unintended consequences of PMPs. This paper outlines some key considerations when starting the conversation with patients about their BDZ use.
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Affiliation(s)
- Erin Oldenhof
- School of Psychology, Deakin University, Geelong, VIC 3220, Australia (K.H.)
- Reconnexion, Malvern East, Melbourne 3145, Australia;
| | | | - Kate Hall
- School of Psychology, Deakin University, Geelong, VIC 3220, Australia (K.H.)
- Centre for Drug Use, Addictive and Anti-social Behaviour Research (CEDAAR), Deakin University, Geelong, VIC 3220, Australia
| | - Petra K. Staiger
- School of Psychology, Deakin University, Geelong, VIC 3220, Australia (K.H.)
- Centre for Drug Use, Addictive and Anti-social Behaviour Research (CEDAAR), Deakin University, Geelong, VIC 3220, Australia
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Collins JC, Hillman JM, Schneider CR, Moles RJ. Supply of codeine combination analgesics from Australian pharmacies in the context of voluntary real-time recording and regulatory change: A simulated patient study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 74:216-222. [DOI: 10.1016/j.drugpo.2019.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 08/01/2019] [Accepted: 10/16/2019] [Indexed: 12/29/2022]
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Martins SS, Ponicki W, Smith N, Rivera-Aguirre A, Davis CS, Fink DS, Castillo-Carniglia A, Henry SG, Marshall BDL, Gruenewald P, Cerdá M. Prescription drug monitoring programs operational characteristics and fatal heroin poisoning. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 74:174-180. [PMID: 31627159 PMCID: PMC6897357 DOI: 10.1016/j.drugpo.2019.10.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 09/29/2019] [Accepted: 10/01/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Prescription drug monitoring programs (PDMP), by reducing access to prescribed opioids (POs), may contribute to a policy environment in which some people with opioid dependence are at increased risk for transitioning from POs to heroin/other illegal opioids. This study examines how PDMP adoption and changes in the characteristics of PDMPs over time contribute to changes in fatal heroin poisoning in counties within states from 2002 to 2016. METHODS Latent transition analysis to classify PDMPs into latent classes (Cooperative, Proactive, and Weak) for each state and year, across three intervals (1999-2004, 2005-2009, 2010-2016). We examined the association between probability of PDMP latent class membership and the rate of county-level heroin poisoning death. RESULTS After adjustment for potential county-level confounders and co-occurring policy changes, adoption of a PDMP was significantly associated with increased heroin poisoning rates (22% increase by third year post-adoption). Findings varied by PDMP type. From 2010-2016, states with Cooperative PDMPs (those more likely to share data with other states, to require more frequent reporting, and include more drug schedules) had 19% higher heroin poisoning rates than states with Weak PDMPs (adjusted rate ratio [ARR] = 1.19; 95% CI = 1.14, 1.25). States with Proactive PDMPs (those more likely to report outlying prescribing and dispensing and provide broader access to law enforcement) had 6% lower heroin poisoning rates than states with No/Weak PDMPs (ARR = 0.94; 95% CI = 0.90, 0.98). CONCLUSION There is a consistent, positive association between state PDMP adoption and heroin poisoning mortality. However, this varies by PDMP type, with Proactive PDMPs associated with a small reduction in heroin poisoning deaths. This raises questions about the potential for PDMPs to support efforts to decrease heroin overdose risk, particularly by using proactive alerts to identify patients in need of treatment for opioid use disorder. Future research on mechanisms explaining the reduction in heroin poisonings after enactment of Proactive PDMPs is merited.
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Affiliation(s)
- Silvia S Martins
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States.
| | - William Ponicki
- Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, CA, United States
| | - Nathan Smith
- Violence Prevention Research Program, Department of Emergency Medicine, UC Davis School of Medicine, CA, United States
| | - Ariadne Rivera-Aguirre
- Violence Prevention Research Program, Department of Emergency Medicine, UC Davis School of Medicine, CA, United States; Department of Population Health, NYU School of Medicine, New York, NY, United States
| | - Corey S Davis
- Network for Public Health Law, Los Angeles, CA, United States
| | - David S Fink
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
| | | | - Stephen G Henry
- Department of Internal Medicine, University of California Davis, Sacramento, CA, United States
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, United States
| | - Paul Gruenewald
- Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, CA, United States
| | - Magdalena Cerdá
- Department of Population Health, NYU School of Medicine, New York, NY, United States
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Hinami K, Ray MJ, Doshi K, Torres M, Aks S, Shannon JJ, Trick WE. Prescribing Associated with High-Risk Opioid Exposures Among Non-cancer Chronic Users of Opioid Analgesics: a Social Network Analysis. J Gen Intern Med 2019; 34:2443-2450. [PMID: 31420823 PMCID: PMC6848735 DOI: 10.1007/s11606-019-05114-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 01/22/2019] [Accepted: 05/17/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND The continued rise in fatalities from opioid analgesics despite a steady decline in the number of individual prescriptions directing ≥ 90 morphine milligram equivalents (MME)/day may be explained by patient exposures to redundant prescriptions from multiple prescribers. OBJECTIVES We evaluated prescribers' specialty and social network characteristics associated with high-risk opioid exposures resulting from single-prescriber high-daily dose prescriptions or multi-prescriber discoordination. DESIGN Retrospective cohort study. PARTICIPANTS A cohort of prescribers with opioid analgesic prescription claims for non-cancer chronic opioid users in an Illinois Medicaid managed care program in 2015-2016. MAIN MEASURES Per prescriber rates of single-prescriber high-daily-dose prescriptions or multi-prescriber discoordination. KEY RESULTS For 2280 beneficiaries, 36,798 opioid prescription claims were submitted by 3532 prescribers. Compared to 3% of prescriptions (involving 6% of prescribers and 7% of beneficiaries) that directed ≥ 90 MME/day, discoordination accounted for a greater share of high-risk exposures-13% of prescriptions (involving 23% of prescribers and 24% of beneficiaries). The following specialties were at highest risk of discoordinated prescribing compared to internal medicine: dental (incident rate ratio (95% confidence interval) 5.9 (4.6, 7.5)), emergency medicine (4.7 (3.8, 5.8)), and surgical subspecialties (4.2 (3.0, 5.8)). Social network analysis identified 2 small interconnected prescriber communities of high-volume pain management specialists, and 3 sparsely connected groups of predominantly low-volume primary care or emergency medicine clinicians. Using multivariate models, we found that the sparsely connected sociometric positions were a risk factor for high-risk exposures. CONCLUSION Low-volume prescribers in the social network's periphery were at greater risk of intended or discoordinated prescribing than interconnected high-volume prescribers. Interventions addressing discoordination among low-volume opioid prescribers in non-integrated practices should be a priority. Demands for enhanced functionality and integration of Prescription Drug Monitoring Programs or referrals to specialized multidisciplinary pain management centers are potential policy implications.
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Affiliation(s)
- Keiki Hinami
- Department of Medicine, Cook County Health, Chicago, IL, USA. .,Collaborative Research Unit, Cook County Health , Chicago, IL, USA. .,Section of Preventive Medicine, Cook County Health, Chicago, IL, USA.
| | - Michael J Ray
- Department of Medicine, Cook County Health, Chicago, IL, USA.,Collaborative Research Unit, Cook County Health , Chicago, IL, USA
| | - Kruti Doshi
- Department of Medicine, Cook County Health, Chicago, IL, USA.,Collaborative Research Unit, Cook County Health , Chicago, IL, USA
| | - Maria Torres
- Department of Anesthesiology, Division of Pain Management, Cook County Health , Chicago, IL, USA
| | - Steven Aks
- Department of Emergency Medicine, Division of Medical Toxicology, Cook County Health , Chicago, IL, USA
| | - John J Shannon
- Department of Medicine, Cook County Health, Chicago, IL, USA
| | - William E Trick
- Department of Medicine, Cook County Health, Chicago, IL, USA.,Collaborative Research Unit, Cook County Health , Chicago, IL, USA
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Islam MM, Wollersheim D. A comparison of opioids and benzodiazepines dispensing in Australia. PLoS One 2019; 14:e0221438. [PMID: 31425552 PMCID: PMC6699700 DOI: 10.1371/journal.pone.0221438] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 08/06/2019] [Indexed: 11/19/2022] Open
Abstract
Background Inappropriate utilization of prescription opioids and benzodiazepines is a public health problem. This study examined and compared user-types and trends in dispensing of these medicines, and identified associated factors related to the duration of dispensing in Australia. Methods A random 10% sample of unit-record data of opioids and benzodiazepines dispensed nationally during 2013–2016 was analyzed. Users were categorized into four types: single-quarter (i.e., three months), medium-episodic (dispensed 2–6 quarters), long-episodic (dispensed 7–11 quarters), chronic (dispensed 12–16 quarters). Dispensing quantity was computed in defined daily dose (DDD). Generalized multilevel ordinal models were developed to examine the factors associated with the duration of dispensing. Results There were similarities in terms of trends of dispensing of opioids and benzodiazepines in Australia. Overall, more people were dispensed opioids than benzodiazepines. Around 52% of opioids users and 46% of benzodiazepines users were dispensed these medicines for a single quarter. However, chronic users were dispensed 60% of opioids and 50% of benzodiazepines in DDD/1000 people/day, respectively. On average, 16.6 DDD/1000 people/day of opioids and 14.2 DDD/1000 people/day of benzodiazepines were dispensed in Australia during the study period. Tasmania was dispensed the highest quantity (in DDD/1000 people/day) of these medicines, followed by South Australia and Queensland. Women compared to men, and clients of age-group 20–44, 45–64 and 65+ compared to age-group 0–19, were significantly more likely to have dispensed opioids/benzodiazepine for a relatively long duration. Clients with a history of dispensing of one of these two medicines were significantly more likely to have dispensed the other for a relatively long period. Conclusions There were similarities in patterns of dispensing of opioids and benzodiazepines in terms of user characteristics and structural variables. Consistent use of real-time drug monitoring program and tailored intervention are recommended.
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Affiliation(s)
- M. Mofizul Islam
- Department of Public Health, La Trobe University, Melbourne, Victoria, Australia
- * E-mail:
| | - Dennis Wollersheim
- Health Information Management, Department of Public Health, La Trobe University, Melbourne, Victoria, Australia
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Soffin EM, Lee BH, Kumar KK, Wu CL. The prescription opioid crisis: role of the anaesthesiologist in reducing opioid use and misuse. Br J Anaesth 2019; 122:e198-e208. [PMID: 30915988 PMCID: PMC8176648 DOI: 10.1016/j.bja.2018.11.019] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 11/12/2018] [Accepted: 11/12/2018] [Indexed: 12/14/2022] Open
Abstract
Reports of strategies to prevent and treat the opioid epidemic are growing. Significant attention has been paid to the benefits of opioid addiction research, clinical prescribing, and public policy initiatives in curbing the epidemic. However, the role of the anaesthesiologist in minimising opioid use and misuse remains underexplored. For many patients with an opioid use disorder, the perioperative period represents the source of initial exposure. As perioperative physicians, anaesthesiologists are in the unique position to manage pain effectively while simultaneously decreasing opioid consumption. Multiple opportunities exist for anaesthesiologists to minimise opioid exposure and prevent subsequent persistent opioid use. We present a global strategy for decreasing perioperative opioid use and misuse among surgical patients. A historical perspective of the opioid epidemic is presented, together with an analysis of opioid supply and demand forces. We then present specific temporal strategies for opioid use reduction in the perioperative period. We emphasise the importance of preoperative identification of patients at risk for long-term opioid use and misuse, review the evidence supporting the opioid sparing capacity of individual multimodal analgesic agents, and discuss the benefits of regional anaesthesia for minimising opioid consumption. We describe postoperative and post-discharge tools, including effective multimodal analgesia and the role of a transitional pain service. Finally, we offer general institutional strategies that can be led by anaesthesiologists, identify gaps in knowledge, and offer directions for future research.
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Affiliation(s)
- Ellen M Soffin
- Department of Anesthesiology, Hospital for Special Surgery, New York, NY, USA; Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | - Bradley H Lee
- Department of Anesthesiology, Hospital for Special Surgery, New York, NY, USA; Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | - Kanupriya K Kumar
- Department of Anesthesiology, Hospital for Special Surgery, New York, NY, USA; Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | - Christopher L Wu
- Department of Anesthesiology, Hospital for Special Surgery, New York, NY, USA; Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA; Armstrong Institute for Patient Safety and Quality, Johns Hopkins University, Baltimore, MD, USA.
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Abstract
PURPOSE We aimed to produce comprehensive guidelines and recommendations that can be utilized by orthopaedic practices as well as other specialties to improve the management of acute pain following musculoskeletal injury. METHODS A panel of 15 members with expertise in orthopaedic trauma, pain management, or both was convened to review the literature and develop recommendations on acute musculoskeletal pain management. The methods described by the Grading of Recommendations Assessment, Development, and Evaluation Working Group were applied to each recommendation. The guideline was submitted to the Orthopaedic Trauma Association (OTA) for review and was approved on October 16, 2018. RESULTS We present evidence-based best practice recommendations and pain medication recommendations with the hope that they can be utilized by orthopaedic practices as well as other specialties to improve the management of acute pain following musculoskeletal injury. Recommendations are presented regarding pain management, cognitive strategies, physical strategies, strategies for patients on long term opioids at presentation, and system implementation strategies. We recommend the use of multimodal analgesia, prescribing the lowest effective immediate-release opioid for the shortest period possible, and considering regional anesthesia. We also recommend connecting patients to psychosocial interventions as indicated and considering anxiety reduction strategies such as aromatherapy. Finally, we also recommend physical strategies including ice, elevation, and transcutaneous electrical stimulation. Prescribing for patients on long term opioids at presentation should be limited to one prescriber. Both pain and sedation should be assessed regularly for inpatients with short, validated tools. Finally, the group supports querying the relevant regional and state prescription drug monitoring program, development of clinical decision support, opioid education efforts for prescribers and patients, and implementing a department or organization pain medication prescribing strategy or policy. CONCLUSIONS Balancing comfort and patient safety following acute musculoskeletal injury is possible when utilizing a true multimodal approach including cognitive, physical, and pharmaceutical strategies. In this guideline, we attempt to provide practical, evidence-based guidance for clinicians in both the operative and non-operative settings to address acute pain from musculoskeletal injury. We also organized and graded the evidence to both support recommendations and identify gap areas for future research.
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Pierce DP, Pierce B, Cheng CI, Perzhinsky J. Assessing treatment and monitoring of musculoskeletal conditions using opioid versus nonopioid therapy: A cross-sectional study. Medicine (Baltimore) 2019; 98:e15128. [PMID: 30985677 PMCID: PMC6486177 DOI: 10.1097/md.0000000000015128] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The purpose of this study is to examine the treatment of noncancer musculoskeletal pain in different clinical settings by assessing patient demographics, pain diagnoses, opioid analgesic monitoring, and alternative treatments.Data was collected in a retrospective chart review involving 300 randomly selected charts with an active musculoskeletal diagnosis based on the 10th revision of the International Statistical Classification of Diseases and Related Health Problems codes. The population consisted of primary care outpatient clinic and emergency department encounters during the timeframe of January 1, 2016 to March 31, 2016 in a predominantly rural community in Michigan. Variables included prescription medications, musculoskeletal conditions, and prescription drug monitoring modalities. Statistical analysis was accomplished using means, standard deviations, proportions, 2-sample proportional tests, multivariable logistic regression, and multinomial regression models.Opioid prescribing was observed in 64% of outpatient and 68.9% of emergency department encounters. Back pain was the most common problem with 61.9% patients prescribed opioids having at least 1 diagnosis of back pain. Patients on opioids were older (mean age 58) than patients taking nonopioids (mean age 50). For every year of increasing age, there is a 3.1% increase in the odds of an opioid being prescribed (odds ratio 1.03, confidence interval 1.012-1.049, P = .001). Documentation was extremely low with only 15.2%, 1.5%, and 1.5% of patient charts prescribed opioids demonstrating documentation of urine drug screens, pain agreements, and review of a state prescription drug monitoring program, respectively.Despite drug monitoring recommendations, low rates of monitoring were observed. Back pain was the largest contributing pain location and had higher opioid use compared to other sites. Many patients had additional pain medications being concurrently prescribed with opioids suggesting that musculoskeletal pain is not often controlled by a single medication type. Reported alcohol abuse, active tobacco use, and illicit substance use can serve as predictors when assessing patients for pain management options. The use of alternative measures and integrative treatment modalities (which saw low utilization in this study) should be implemented as either primary or supplementary therapy as a way to reduce the pharmacologic burden on the patient.
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Affiliation(s)
- Derek P.R. Pierce
- Central Michigan University (CMU) College of Medicine, Mt. Pleasant, MI
| | | | | | - Juliette Perzhinsky
- Central Michigan University (CMU) College of Medicine, Mt. Pleasant, MI
- CMU Health
- Aleda E. Lutz VA Medical Center, Saginaw, MI
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Mospan G, Gillette C, Chaplin M, Bush M. Do more opioid policies reduce opioid dispensing in traditional medicaid?: A national analysis. Res Social Adm Pharm 2018; 15:1000-1006. [PMID: 30579803 DOI: 10.1016/j.sapharm.2018.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 11/09/2018] [Accepted: 12/06/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Several Medicaid programs have implemented approaches to ensure the appropriateness of opioid utilization and decrease opioid dispensing. OBJECTIVE To evaluate whether Medicaid opioid harm reduction strategies (OHRS) resulted in a decrease in opioid claims, costs, or units reimbursed per beneficiary. METHODS The number of OHRS was determined for each state's fee-for-service (FFS) Medicaid program according to previously published data. Publically available FFS Medicaid data were tabulated by state for opioid claims, costs, and units reimbursed in state fiscal years 2016 and 2017. Multivariable generalized estimating equation (GEE) models were utilized to analyze the data. RESULTS GEE results indicated that OHRS intensity or change in OHRS did not impact opioid claims or units reimbursed in Medicaid FFS programs. A significant finding on reduction in beneficiary-adjusted opioid costs was observed for states with two OHRS compared to states with no OHRS. There were no significant differences in opioid claims, units reimbursed, and costs based on states with 3 or fewer OHRS versus those with four or more. When examining the differential effect of each individual type of OHRS, there were no significant differences in opioid claims, units reimbursed, nor medication costs. CONCLUSIONS The number of OHRS may not be associated with opioid dispensing or utilization in FFS Medicaid programs. Other factors may have led to the decrease in opioid claims for Medicaid.
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Affiliation(s)
- Geoffrey Mospan
- Wingate University School of Pharmacy, Wingate, NC, 515 N Main Street, Wingate, NC, 28174, USA.
| | - Chris Gillette
- Wingate University School of Pharmacy, Wingate, NC, 515 N Main Street, Wingate, NC, 28174, USA
| | - Michelle Chaplin
- Wingate University School of Pharmacy, Hendersonville, NC, 805 6th Avenue West, Hendersonville, NC, 28739, USA
| | - Mark Bush
- Wingate University School of Pharmacy, Wingate, NC, 515 N Main Street, Wingate, NC, 28174, USA
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Ponnapalli A, Grando A, Murcko A, Wertheim P. Systematic Literature Review of Prescription Drug Monitoring Programs. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2018; 2018:1478-1487. [PMID: 30815193 PMCID: PMC6371270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Prescription opioid abuse has become a serious national problem. To respond to the opioid epidemic, states have implemented prescription drug monitoring programs (PDMPs) to monitor and reduce opioid abuse. We conducted a systematic literature review to better understand the PDMP impact on reducing opioid abuse, improving prescriber practices, and how EHR integration has impacted PDMP usability. Lessons learned can help guide federal and state-based efforts to better respond to the opioid crisis.
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Affiliation(s)
| | | | | | - Pete Wertheim
- Arizona Osteopathic Medical Association, Phoenix, Arizona
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McCauley JL, Gilbert GH, Cochran DL, Gordan VV, Leite RS, Fillingim RB, Brady KT. Prescription Drug Monitoring Program Use: National Dental PBRN Results. JDR Clin Trans Res 2018; 4:178-186. [PMID: 30931705 DOI: 10.1177/2380084418808517] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION The American Dental Association recommends that dentists use a prescription drug monitoring program (PDMP) prior to prescribing an opioid for acute pain management. OBJECTIVE The objective of this study was to examine dentists' experiences using their state PDMP, as well as the impact that state-mandated registration policies, mandated use policies, and practice characteristics had on the frequency with which dentists used their PDMP. METHODS We conducted a web-based cross-sectional survey among practicing dentist members of the National Dental Practice-Based Research Network ( n = 805). The survey assessed prescribing practices for pain management and implementation of risk mitigation strategies, including PDMP use. Survey data were linked with network Enrollment Questionnaire data to include practitioner demographics and practice characteristics. RESULTS Nearly half of respondents ( n = 375, 46.6%) reported having never accessed a PDMP, with the most common reasons for nonaccess being lack of awareness ( n = 214, 57.1%) and lack of knowledge regarding registration and use ( n = 94, 25.1%). The majority of PDMP users reported the program to be very helpful (58.1%) or somewhat helpful (31.6%). Dentists reported that PDMP use most often did not change their intended prescribing behavior (40.2%), led them not to prescribe an opioid (33.5%), or led them to prescribe fewer opioid doses (25.5%). Presence of a mandated use policy was significantly associated with increased frequency of PDMP use across a variety of situations, including prior to 1) prescribing any opioid for pain management, 2) issuing refills, 3) prescribing to new patients, and 4) prescribing to patients deemed high risk. CONCLUSION Findings suggest that the majority of dentists find PDMPs helpful in informing their opioid-prescribing practices. Whereas the existence of a state-mandated use policy is a consistent predictor of dentists' PDMP use, outreach and education efforts may overcome key barriers to use identified in this study. KNOWLEDGE TRANSFER STATEMENT Findings from this national survey suggest that the majority of practicing dentists find PDMPs helpful in informing their opioid-prescribing practices; however, consistent PDMP use was not common. Whereas the existence of a state-mandated use policy is a consistent predictor of dentists' PDMP use, outreach and education efforts may overcome key barriers to use identified in this study.
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Affiliation(s)
- J L McCauley
- 1 Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - G H Gilbert
- 2 Department of Clinical and Community Sciences, University of Alabama at Birmingham, Birmingham, USA
| | - D L Cochran
- 3 Department of Periodontics, UT Health San Antonio, San Antonio, USA
| | - V V Gordan
- 4 Department of Restorative Dental Sciences, University of Florida, Gainesville, FL, USA
| | - R S Leite
- 5 Department of Stomatology, Medical University of South Carolina, Charleston, SC, USA
| | - R B Fillingim
- 6 Department of Restorative Dental Sciences, University of Florida, USA
| | - K T Brady
- 1 Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.,7 Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
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- 8 National Dental PBRN Collaborative Group, which includes practitioner, faculty, and staff investigators who contributed to this activity ( http://nationaldentalpbrn.org/collaborative-group.php )
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Sun BC, Lupulescu-Mann N, Charlesworth CJ, Kim H, Hartung DM, Deyo RA, John McConnell K. Variations in prescription drug monitoring program use by prescriber specialty. J Subst Abuse Treat 2018; 94:35-40. [PMID: 30243415 DOI: 10.1016/j.jsat.2018.08.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 08/13/2018] [Accepted: 08/14/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although prescription drug monitoring programs (PDMPs) have been widely implemented to potentially reduce abuse of prescription opioids, there is limited data on variations in PDMP use by prescriber specialty. Such knowledge may guide targeted interventions to improve PDMP use. METHODS Using data from Washington state Medicaid program, we performed a retrospective cohort study of opioid prescribers and their PDMP queries between Nov 1, 2013 and Oct 31, 2014. PDMP registration was mandatory for emergency physicians, but not for other providers. The unit of analysis was the prescriber. The primary outcome was any prescriber queries of the PDMP. We used multivariate regression models to identify variations in PDMP queries by prescriber specialty, as well as to explore explanatory pathways for observed variations. RESULTS We studied 17,390 providers who prescribed opioids, including 8718 (50%) who were not registered with PDMP, 4767 (27%) who were registered but had no recorded use of the PDMP, and 3905 (23%) PDMP users (queries/user: median 18, IQR 5-64). Compared to general medicine physicians, PDMP use was higher for emergency physicians (OR 1.4, 95%CI: 1.2-1.7), and lower for surgical specialists (OR 0.1, 95%CI: 0.08-0.1), obstetrician-gynecologists (OR 0.2, 95%CI: 0.1-0.2) and dentists (OR 0.4, 95%CI: 0.4-0.5). Higher use by emergency physicians appeared to be mediated by higher registration rates, rather than by provider level predilection to use the PDMP. CONCLUSIONS A minority of opioid prescribers to Medicaid beneficiaries used the PDMP. We identified variations in PDMP use by prescriber specialty. Interventions to increase PDMP queries should target both PDMP registration and PDMP use after registration, as well as specialties with current low use rates.
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Affiliation(s)
- Benjamin C Sun
- Center for Policy Research-Emergency Medicine, Department of Emergency Medicine, Oregon Health and Science University, Portland, OR, United States of America.
| | - Nicoleta Lupulescu-Mann
- Center for Health Systems Effectiveness, Oregon Health and Science University, Portland, OR, United States of America
| | - Christina J Charlesworth
- Center for Health Systems Effectiveness, Oregon Health and Science University, Portland, OR, United States of America
| | - Hyunjee Kim
- Center for Health Systems Effectiveness, Oregon Health and Science University, Portland, OR, United States of America
| | - Daniel M Hartung
- College of Pharmacy, Oregon State University/Oregon Health and Science University, Portland, OR, United States of America
| | - Richard A Deyo
- Department of Family Medicine, Department of Medicine, Department of Public Health and Preventive Medicine, and Oregon Institute of Occupational Health Sciences, Oregon Health and Science University, Portland, OR, United States of America
| | - K John McConnell
- Center for Policy Research-Emergency Medicine, Department of Emergency Medicine, Oregon Health and Science University, Portland, OR, United States of America; Center for Health Systems Effectiveness, Oregon Health and Science University, Portland, OR, United States of America
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