Association of Prescription Drug Monitoring Program Use With Opioid Prescribing and Health Outcomes: A Comparison of Program Users and Nonusers

Richard A. Deyo, Sara E. Hallvik, Christi Hildebran, Miguel Marino, Rachel Springer, Jessica M. Irvine, Nicole O'Kane, Joshua Van Otterloo, Dagan A. Wright, Gillian Leichtling, Lisa M. Millet, Jody Carson, Wayne Wakeland, Dennis McCarty

Research output: Contribution to journalArticle

Abstract

Prescription drug monitoring programs (PDMPs) are a response to the prescription opioid epidemic, but their effects on prescribing and health outcomes remain unclear, with conflicting reports. We sought to determine if prescriber use of Oregon's PDMP led to fewer high-risk opioid prescriptions or overdose events. We conducted a retrospective cohort study from October 2011 through October 2014, using statewide PDMP data, hospitalization registry, and vital records. Early PDMP registrants (n = 927) were matched with clinicians who never registered during the study period, using baseline prescribing metrics in a propensity score. Generalized estimating equations were used to examine prescribing trends after PDMP registration, using 2-month intervals. We found a statewide decline in measures of per capita opioid prescribing. However, compared with nonregistrants, PDMP registrants did not subsequently have significantly fewer patients receiving high-dose prescriptions, overlapping opioid and benzodiazepine prescriptions, inappropriate prescriptions, prescriptions from multiple prescribers, or overdose events. At baseline, frequent PDMP users wrote fewer high-risk opioid prescriptions than infrequent users; this persisted during follow-up with few significant group differences in trend. Thus, although opioid prescribing declined statewide after implementing the PDMP, registrants did not show greater declines than nonregistrants. Perspective: Factors other than PDMP use may have had greater influence on prescribing trends. Refinements in the PDMP program and related policies may be necessary to increase PDMP effects.

LanguageEnglish (US)
JournalJournal of Pain
DOIs
StateAccepted/In press - Jan 1 2017

Fingerprint

Prescription Drugs
Drug Monitoring
Opioid Analgesics
Health
Prescriptions
Inappropriate Prescribing
Propensity Score
Benzodiazepines
Registries
Hospitalization
Cohort Studies
Retrospective Studies

Keywords

  • Cohort study
  • Health policy
  • Opioids
  • Prescription drug monitoring program
  • Risky prescribing

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Anesthesiology and Pain Medicine

Cite this

Association of Prescription Drug Monitoring Program Use With Opioid Prescribing and Health Outcomes : A Comparison of Program Users and Nonusers. / Deyo, Richard A.; Hallvik, Sara E.; Hildebran, Christi; Marino, Miguel; Springer, Rachel; Irvine, Jessica M.; O'Kane, Nicole; Van Otterloo, Joshua; Wright, Dagan A.; Leichtling, Gillian; Millet, Lisa M.; Carson, Jody; Wakeland, Wayne; McCarty, Dennis.

In: Journal of Pain, 01.01.2017.

Research output: Contribution to journalArticle

Deyo, RA, Hallvik, SE, Hildebran, C, Marino, M, Springer, R, Irvine, JM, O'Kane, N, Van Otterloo, J, Wright, DA, Leichtling, G, Millet, LM, Carson, J, Wakeland, W & McCarty, D 2017, 'Association of Prescription Drug Monitoring Program Use With Opioid Prescribing and Health Outcomes: A Comparison of Program Users and Nonusers' Journal of Pain. DOI: 10.1016/j.jpain.2017.10.001
Deyo, Richard A. ; Hallvik, Sara E. ; Hildebran, Christi ; Marino, Miguel ; Springer, Rachel ; Irvine, Jessica M. ; O'Kane, Nicole ; Van Otterloo, Joshua ; Wright, Dagan A. ; Leichtling, Gillian ; Millet, Lisa M. ; Carson, Jody ; Wakeland, Wayne ; McCarty, Dennis. / Association of Prescription Drug Monitoring Program Use With Opioid Prescribing and Health Outcomes : A Comparison of Program Users and Nonusers. In: Journal of Pain. 2017
@article{4f9f860ffb9b48e696e9291813e3df03,
title = "Association of Prescription Drug Monitoring Program Use With Opioid Prescribing and Health Outcomes: A Comparison of Program Users and Nonusers",
abstract = "Prescription drug monitoring programs (PDMPs) are a response to the prescription opioid epidemic, but their effects on prescribing and health outcomes remain unclear, with conflicting reports. We sought to determine if prescriber use of Oregon\{textquoteleft}s PDMP led to fewer high-risk opioid prescriptions or overdose events. We conducted a retrospective cohort study from October 2011 through October 2014, using statewide PDMP data, hospitalization registry, and vital records. Early PDMP registrants (n = 927) were matched with clinicians who never registered during the study period, using baseline prescribing metrics in a propensity score. Generalized estimating equations were used to examine prescribing trends after PDMP registration, using 2-month intervals. We found a statewide decline in measures of per capita opioid prescribing. However, compared with nonregistrants, PDMP registrants did not subsequently have significantly fewer patients receiving high-dose prescriptions, overlapping opioid and benzodiazepine prescriptions, inappropriate prescriptions, prescriptions from multiple prescribers, or overdose events. At baseline, frequent PDMP users wrote fewer high-risk opioid prescriptions than infrequent users; this persisted during follow-up with few significant group differences in trend. Thus, although opioid prescribing declined statewide after implementing the PDMP, registrants did not show greater declines than nonregistrants. Perspective: Factors other than PDMP use may have had greater influence on prescribing trends. Refinements in the PDMP program and related policies may be necessary to increase PDMP effects.",
keywords = "Cohort study, Health policy, Opioids, Prescription drug monitoring program, Risky prescribing",
author = "Deyo, {Richard A.} and Hallvik, {Sara E.} and Christi Hildebran and Miguel Marino and Rachel Springer and Irvine, {Jessica M.} and Nicole O\{textquoteleft}Kane and {Van Otterloo}, Joshua and Wright, {Dagan A.} and Gillian Leichtling and Millet, {Lisa M.} and Jody Carson and Wayne Wakeland and Dennis McCarty",
year = "2017",
month = "1",
day = "1",
doi = "10.1016/j.jpain.2017.10.001",
language = "English (US)",
journal = "Journal of Pain",
issn = "1526-5900",
publisher = "Churchill Livingstone",

}

TY - JOUR

T1 - Association of Prescription Drug Monitoring Program Use With Opioid Prescribing and Health Outcomes

T2 - Journal of Pain

AU - Deyo,Richard A.

AU - Hallvik,Sara E.

AU - Hildebran,Christi

AU - Marino,Miguel

AU - Springer,Rachel

AU - Irvine,Jessica M.

AU - O'Kane,Nicole

AU - Van Otterloo,Joshua

AU - Wright,Dagan A.

AU - Leichtling,Gillian

AU - Millet,Lisa M.

AU - Carson,Jody

AU - Wakeland,Wayne

AU - McCarty,Dennis

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Prescription drug monitoring programs (PDMPs) are a response to the prescription opioid epidemic, but their effects on prescribing and health outcomes remain unclear, with conflicting reports. We sought to determine if prescriber use of Oregon's PDMP led to fewer high-risk opioid prescriptions or overdose events. We conducted a retrospective cohort study from October 2011 through October 2014, using statewide PDMP data, hospitalization registry, and vital records. Early PDMP registrants (n = 927) were matched with clinicians who never registered during the study period, using baseline prescribing metrics in a propensity score. Generalized estimating equations were used to examine prescribing trends after PDMP registration, using 2-month intervals. We found a statewide decline in measures of per capita opioid prescribing. However, compared with nonregistrants, PDMP registrants did not subsequently have significantly fewer patients receiving high-dose prescriptions, overlapping opioid and benzodiazepine prescriptions, inappropriate prescriptions, prescriptions from multiple prescribers, or overdose events. At baseline, frequent PDMP users wrote fewer high-risk opioid prescriptions than infrequent users; this persisted during follow-up with few significant group differences in trend. Thus, although opioid prescribing declined statewide after implementing the PDMP, registrants did not show greater declines than nonregistrants. Perspective: Factors other than PDMP use may have had greater influence on prescribing trends. Refinements in the PDMP program and related policies may be necessary to increase PDMP effects.

AB - Prescription drug monitoring programs (PDMPs) are a response to the prescription opioid epidemic, but their effects on prescribing and health outcomes remain unclear, with conflicting reports. We sought to determine if prescriber use of Oregon's PDMP led to fewer high-risk opioid prescriptions or overdose events. We conducted a retrospective cohort study from October 2011 through October 2014, using statewide PDMP data, hospitalization registry, and vital records. Early PDMP registrants (n = 927) were matched with clinicians who never registered during the study period, using baseline prescribing metrics in a propensity score. Generalized estimating equations were used to examine prescribing trends after PDMP registration, using 2-month intervals. We found a statewide decline in measures of per capita opioid prescribing. However, compared with nonregistrants, PDMP registrants did not subsequently have significantly fewer patients receiving high-dose prescriptions, overlapping opioid and benzodiazepine prescriptions, inappropriate prescriptions, prescriptions from multiple prescribers, or overdose events. At baseline, frequent PDMP users wrote fewer high-risk opioid prescriptions than infrequent users; this persisted during follow-up with few significant group differences in trend. Thus, although opioid prescribing declined statewide after implementing the PDMP, registrants did not show greater declines than nonregistrants. Perspective: Factors other than PDMP use may have had greater influence on prescribing trends. Refinements in the PDMP program and related policies may be necessary to increase PDMP effects.

KW - Cohort study

KW - Health policy

KW - Opioids

KW - Prescription drug monitoring program

KW - Risky prescribing

UR - http://www.scopus.com/inward/record.url?scp=85036609231&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85036609231&partnerID=8YFLogxK

U2 - 10.1016/j.jpain.2017.10.001

DO - 10.1016/j.jpain.2017.10.001

M3 - Article

JO - Journal of Pain

JF - Journal of Pain

SN - 1526-5900

ER -