Prescribing Habits

Colleen Carey

Research casts spotlight on drug monitoring trends

More than 2 million people in the U.S. are currently addicted to opioids and approximately 130 people die each day from overdoses. The opioid crisis – in which millions of people across the U.S. have become addicted to prescription painkillers – remains a growing problem, and was declared a public health emergency by the Department of Health and Human Services in 2017.

Health economist Colleen Carey, an assistant professor in the Department of Policy Analysis and Management, is studying one solution to this devastating problem: state-level prescription drug monitoring programs, or PDMPs.

PDMPs work like this: A state collects data from pharmacies on how often patients receive prescriptions for opioids and from whom. Doctors can check how many prescriptions a patient has filled in the past and whether they are “shopping around” for drugs from other doctors. Although 27 states established these databases from 2000 to 2010, with more doing so since, most doctors were not using the data.

Over the past 12 years, states began passing laws that require doctors to check the databases before prescribing opioids. The first was Kentucky in 2012, and since then 42 more states have enacted these laws.

Carey, along with two colleagues from the University of Michigan, has written two papers that measure what effect these policies have on the opioid crisis on the whole.

“One thing that has interested me about this topic is that the problem began in the medical industry,” Carey said. “This wasn’t driven by drug cartels in its initial form. For me, that raised a lot of questions about the power that we give to doctors and the ways in which the medical community polices itself or fails to police itself.”

The most recent paper, which is under review, compares two states – Kentucky, the first to enact a strict PDMP, and Indiana, which did not have a strict PDMP at the time of the analysis (Indiana has since passed a stricter law).

Their analysis found that, relative to Indiana, forty percent of doctors in Kentucky who were considered “low-volume” prescribers of opioids stopped prescribing the medications all together after the strict policy took effect. Other Kentucky doctors prescribed opioids to about 16% fewer patients.

The analysis also found that doctors stopped prescribing to patients whose history suggested they were getting opioids from multiple doctors. However, doctors also reduced prescribing to patients with no recent opioid use, suggesting that patients who were recovering from an injury or surgery were also less likely to receive opioids.

“Overall, I would say our research has demonstrated the policies are helpful,” Carey said. “Getting the medical industry out of the drug distribution business is a good thing. Unnecessary prescriptions were a corrupting problem, and I remain horrified that this went on as long as it did.”

Carey does highlight two potential downsides to strict PDMPs. First, there is a chance that these policies are preventing some patients who truly need pain relief from getting it. And there is a second potential problem: When PDMPs prevent drug addicts from getting opioids from their doctors, they may be turning to illegal sources and more dangerous drugs, such as fentanyl and heroin. But there is not currently good data to find out if this is actually happening or to what extent, Carey said.

There are also tricky calls for doctors, such as when a patient’s previous record could suggest abuse, but might also suggest a legitimate problem with pain. Still, the research demonstrates the policies are helpful on the whole, she said.

“It turns out if we get the data in front of physicians, they change their prescribing habits,” she said.

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