In an attempt to prevent prescribers from doling out an excessive amount of or unnecessary opioid medications and to decrease the number of opioid overdoses throughout the country, prescription drug monitoring programs (PDMPs) have been implemented. Today, every state has a PDMP, with the exception of Missouri.
According to The Prevalence and Costs of Physician-Dispensed Drugs, physician dispensing of opioids in Florida has been more common than in most states. Florida’s PDMP started on Sept. 1, 2011 and it was found in the 2012 data that the main opioid prescription drugs that were being prescribed were hydrocodone and oxycodone SA.
Peter Kreiner, PhD, who is a scientist at the Schneider Institute for Health Policy and head of the Prescription Drug Monitoring Program Center of Excellence at Brandeis University, spoke at a Workers Compensation Research Institute (WCRI) webinar earlier this month and shared data that his organization collected from the PDMPs across the country, and specifically in Florida.
Kreiner’s research looked at multiple patient risk indicators and prescriber risk indicators, which include multiple provider episodes (MPEs), scenarios where a patient obtains prescriptions from more than one prescriber and fills them at multiple pharmacies. For this study, the phenomenon was defined as having Schedule II drugs prescribed by 5 or more prescribers and dispensed at 5 or more pharmacies during one quarter.
Comparing Quarter 4 of 2011 in Florida (right after the PDMP began) with Quarter 4 of 2012, the rates of MPEs decreased significantly. For example, for the 18-34 age group, the rate per 100,000 residents went from 4.7% to 1.8%. For the 35-54 age group the difference was even more notable – 6.9 % in 2011 to 2.6% in 2012.
Another patient risk indicator that was addressed was daily opioid dosage prescribed. The average morphine milligram equivalent (MME) per day has decreased significantly each quarter since the implementation of the Florida PDMP, and the percentage of people who are receiving more than 100 MME per day is on a slow decline.
One of the prescriber risk indicators examined was the average dosage by prescriber deciles (10% groupings). Most of the decline in prescribing occurred among the top 10% of prescribers. Kreiner says the takeaway from this is that among those top prescribers, there possibly were some who were prescribing inappropriately.
Additionally, the data looked at prescription-related overdose deaths in Florida for 2011 and 2012. Situations where “controlled prescription drug use was the primary or contributing cause of death” decreased from 2,539 in 2011 to 2,090 in 2012, a 17.7% decrease. Also, situations where “Oxycodone was the primary or contributing cause of death” decreased from 1,247 to 735 in 2012, a 41% decline.
Kreiner says Florida medical examiners have taken this issue seriously and continue to take the initiative to get information about overdose-related deaths to researchers and the public as soon as they can. He said Florida officials have released numbers for 2012, while most other states have not yet done that.
The PDMP Center of Excellence, which is funded through a training and technical assistance grant from the U.S. Department of Justice’s Bureau of Justice Assistance (BJA), assists PDMPs by collecting and providing data on prescriptions to prescribers, pharmacies and regulatory agencies.
Kreiner says the Prescription Behavior Surveillance System (PBSS), a longitudinal, multi-state database that exists through the center, serves two purposes:
1. It will be an early warning surveillance tool. In other words, it can help to identify risky behaviors or trends in patients, prescribers or dispensers. The PBSS currently tracks more than 43 different measures of patient, prescriber and pharmacy behavior.
2. It will serve as an evaluation tool when looking at state and local policies and initiatives such as prescriber educational initiatives, prescriber mandates or other initiatives to help influence prescriber behaviors.
The addiction data, prescribing policies and PDMPs differ from state to state. Kreiner says his center is looking into data in Massachusetts now and is finding great geographic variation. Because patterns in various localities are so different, he says that the data can help to answer questions for prevention practitioners to better assess the need and allocation of resources.