Analysis of the PDMP data showed a 33% decrease in overall quantity of opioids prescribed, a 9% decrease in partially filled prescriptions, and an 18% decrease in the authorized refill count, following implementation of a new statewide PDMP. We found a larger decrease in long term prescriptions of opioids versus short term prescriptions, as well as decreasing rates of decline in the third-year post implementation.
Perhaps one of the most clinically significant aspects of the data presented above, is the larger decrease in longer term opioid prescriptions versus short term prescriptions. Currently, as many as one in four patients receiving long-term opioid therapy in a primary care setting struggles with opioid addiction. The longer a patient is on opioids, the higher the likelihood of dependence on the medication and thereby the higher chance of abuse.8,9
Multiple nearby states and areas have published similar opioid reductions alongside a statewide PDMP. In New York, the implementation of a PDMP (I-STOP law) saw a significant decrease in rates of potentially problematic patterns of opioid prescribing,10 as well as a leveling off of prescription opioid mortality.11 In Pittsburgh, Pennsylvania, a PDMP use mandate was associated with fewer patients prescribed opioids in the emergency department than pre-PDMP implementation.12 One study found a 30% reduction in the self-reported rate of schedule ll prescriptions among patients reporting pain as a reason for a visit.6 Data from the state of Florida demonstrated that after the implementation of the PDMP, the Oxycodone-caused mortality abruptly declined 25%13, opioid prescriptions declined 1.4%, opioid volume decreased 2.5%, and MME per transaction decreased 5.6%.14
Since PDMPs are the most researched program established to combat the opioid crises, there exist multiple studies that investigate the various aspects of what makes a good PDMP. Since PDMPs vary by state, it would make sense that certain states will see significant effectiveness and others would not. Multiple studies have shown decreases in opioid-related overdoses and deaths, especially the more “robust” a PDMP is.15-20 “Robustness” with regards to a PDMP may include facets such as: a use and registration mandate, delegate access, proactive reporting, no prescriber immunity for failing to query the PDMP, as well as reporting data to multiple neighboring states.21 Currently, Pennsylvania’s PDMP includes a registration and comprehensive use mandate, proactive reporting, delegate access, but does provide prescriber immunity for failing to query the PDMP.22 This enhances our understanding that effective PDMPs need to be comprehensive and robust to have a significant effect in combating the opioid crises.
The implementation of statewide have brought along some significant challenges for prescribers and others both intentionally and unintentionally. For example, three studies have found an association between PDMP implement and heroin overdose death rates.23,24 This is hypothesized to be due to the intended consequences of lowering prescription opioids in the general public.25 This is mirrored in a qualitative study done in Philadelphia and San Francisco which documented the transition from prescription opioids users to heroin. They found that most heroin users were originally prescribed opioids but found heroin to be a more available and inexpensive option when the supply of opioids became too small and too costly.26 Cases like this show the importance that practitioners have in referring and encouraging those at risk for opioid abuse to seek treatment at treatment centers or by other evidence-based treatment methods.
Healthcare providers have also outlined the problems with implementing and integrating a statewide PDMP – especially a mandatory one – on workflow and time sensitive situations.27 Any online database that is required to be queried in specific situations can lead to uncertainty if the program is not working properly and does not adequately address what prescribers should do when presented with opioid prescribing history of their patients. If policymakers wish to effectively implement a PDMP, it is vital that the program be integrated smoothly into daily workflow and has a contingency plan in case the program is not accessible. Also needed is support for including trends data and enhanced patient profiles that include additional data beyond controlled substances prescribed. This process could be optimized by including frequent and effective collaboration between all stakeholders involed.28