Do Drug Monitoring Programs Work Against the Opioid Epidemic?

Fink

While prescription drug monitoring programs (PDMPs) have been touted by a range of governmental agencies from the White House to the CDC as a major tool to address the opioid epidemic, there’s little evidence to support their effectiveness, according to a new study.

The study, published in the Annals of Internal Medicine, aimed to clarify the relationship between PDMPs and their effectiveness in confronting the nation’s drug problem and found limited to no evidence that they actually work.

Lead study author David S. Fink, MPH, a doctoral candidate in epidemiology at Columbia University, and colleagues identified 17 studies that have examined the association between PDMPs and nonfatal and fatal drug overdoses. This was a systematic review in which the researchers examined five databased to identify all papers that examined the association between PDMPs and nonfatal or fatal overdoses. After identifying the papers, they reviewed each paper for risk of bias and rated the overall strength of evidence.

“In these studies, we found weak support for these programs overall. Because each state’s PDMP is developed based on each state’s desired goals, all PDMPs operate slightly differently, from the agency the program is housed (e.g., law enforcement, public health) to prescriber access to data and frequency of updates,” Fink says.

Thus, the researchers examined the support for particular operational characteristics. “We found some evidence that four features were associated with reductions in overdoses: mandatory provider review, provider authorization to access PDMP data, frequency of reports, and monitoring of non-scheduled drugs,” Fink says. “However, in addition to these findings, three of the six studies that examined the relationship between PDMP implementation and heroin overdoses found a positive association, suggesting a potential unintended consequence associated with these programs.”

With PDMPs now operating in every U.S. state and Washington D.C., PDMPs are likely to become common for prescribers, according to Fink.

“Thus, health executives should view these programs, not as a law enforcement tool, but a useful tool to improve the health of their client population,” he says. “This suggests that providers need to be training on proper management of patients identified as exhibiting potential drug-seeking behaviors. Although it still remains to be investigated, it is possible that PDMPs, when used appropriately, could offer a cost savings benefit, by helping to reduce overdose risk and increase access to medicated-assisted treatments (MAT). Considering the possibility that a patient with multiple provider episodes could be, at the very least, referred to addiction services, and potentially prescribed naloxone or some form of MAT.”

Disturbing finding

The most unique finding is that three of the six papers that examined heroin-related overdoses identified an increase post-PDMP implementation, according to Fink.

“This is a very concerning problem that needs to be considered when supply side restrictions are put into place,” he says. “Whether modifying prescriber guidelines, introducing abuse-deterrent drug formulations, or PDMPs, supply side interventions should be matched with demand side interventions to serve the opioid dependent person who could be adversely affected by such interventions.”

Addiction is a very complicated disease that requires thoughtful policies, specifically policies that consider the drug, the people who use the drug, and their environment, according to Fink. “Drug, person, and setting should all be considered when developing and rolling out new interventions. In addition, interventions advanced to improve population health should be evaluated. This study found limited evidence supporting the enthusiasm with which PDMPs have been advanced,” he says.