One of the most widespread tools being used to fight the opioid epidemic is finally starting to show promise in slightly reducing drug overdoses. But it could have a much higher impact if more states adopt stricter rules, according to new studies.
Prescription drug monitoring programs (PDMP) have been around for a decade, but most of them have failed to live up to their potential. The ultimate goal of PDMPs is to track patients' drug histories to prevent “doctor shopping” (going from provider to provider obtaining different prescriptions), identify people with substance abuse problems and refer them to treatment.
Every state except Missouri has a drug monitoring program, but they vary widely. For example, 29 states require doctors to use them, while 20 make doctors' usage of the databases voluntary. In 2012, fewer than 50 percent of prescribers were using them.
One study in Health Affairs found that the first 24 states to implement PDMPs saw a 30 percent reduction in the rate of prescribing opioids. Some of the states that had the greatest reduction (Indiana, Louisiana and Tennessee) have also been hit hardest by opioid overdoses.
“People who are dependent on prescription drugs will get their hands on it somehow, either with heroin or with illegally made fentanyl,” said Yuhua Bao, associate professor of health-care policy at Weill Cornell Medical College and one of the study's researchers.
Another study in Health Affairs highlights how PDMPs can make more of an impact. It found that if every state maintained strict standards for its database -- such as requiring reporting and monitoring more drugs -- there would be 600 fewer opioid overdose deaths per year. Currently, around 28,000 people a year die of opioid overdose.
But the study also found that in the year a state implemented its program, there was only a reduction of 1.12 opioid deaths per 100,000 people. While a dozen states experienced a decline in opioid overdose deaths from 2013 to 2014, 14 states had a 20 or more percent increase.
“There’s clear room for improvement in many state’s systems," said Stephen Patrick, assistant professor of health policy at Vanderbilt University and lead researcher on the study. "In Tennessee, for example, I have to log into an entirely separate system to access the database. They just need more support; we need to make advances to make them more operable."
There have been more than 100 bills introduced this year regarding PDMPs, according to Heather Gray, legislative director at the National Alliance for Model State Drug Laws. Most recently, Alaska Gov. Bill Walker signed new regulations into law that will make medical providers' participation mandatory and require the databases to be updated weekly.
“It used to be, in Tennessee, if you suspected someone was abusing, your only option was to fire them as a patient. That’s not going to work,” said Gray. "As more providers start using them, we can get early warning signs in place that will make it easier to refer them to treatment."
Health policy experts say these programs are in phase two. More providers are mandated to use them, so now the key is "shifting from the clunky initial launch to lawmakers really leveraging their potential,” said Bao.
“It’s an extremely promising tool, but to what extent it will make a dent in the opioid epidemic remains to be seen. It’s going to take a sea change in how pain medication is prescribed."