States that require providers to use prescription drug monitoring databases (PDMPs) not only have a lower rate of opioid prescriptions, these PDMP mandates also lead to lower rates of opioid-related inpatient stays and emergency department (ED) visits, according to a study published in Health Affairs.
The implementation of comprehensive PDMP mandates was associated with an 8.92% lower rate of opioid prescriptions in the Medicaid population, according to the study that looked at Medicaid prescription data and hospital utilization data across the U.S. from 2011 to 2016.
The study also found that the use of PDMPs might improve health, with comprehensive PDMP mandates associated with reduced rates of opioid-related inpatient stays and ED visits by 4.27% and 17.75%, respectively.
"Our findings suggest that the previously documented reductions in the overall opioid prescription rate and the rate of high-risk opioid prescriptions may have effectively translated into reductions in adverse health care events as a result of opioid misuse and overdose," the study authors said.
The research was led by Hefei Wen, an assistant professor in the department of health management and policy at the University of Kentucky College of Public Health; Jason Hockenberry, an associate professor in the department of health policy and management in Rollins School of Public Health at Emory University; and Weill Cornell Medical College healthcare policy researchers Philip Jeng and Yuhua Bao.
PDMPs have been established in almost the entire U.S.—49 states, the District of Columbia and Guam—and state policy efforts in recent years have shifted from simply establishing PDMPs to improving providers’ participation in the programs. Many states have registration mandates that require all state-licensed prescribers and dispensers to register with and to use the PDMP in most clinical circumstances.
Some industry stakeholders have voiced concerns that the use of these prescription drug databases may push people who have already become dependent on opioids to seek alternative, more dangerous drugs such as heroin and illicitly manufactured fentanyl. The study authors said while they could not "rule out the possibility" that these PDMP mandates are pushing patients to seek out dangerous illegal alternatives like heroin and synthetic opioids, the net effect is positive. "Those increases, if any, were offset by the reduction in prescription opioid-related events," the study authors said.
"Our focus on Medicaid is important in the context of the current opioid crisis because the Medicaid population has been shown to have a disproportionately high risk for chronic pain, as well as for opioid misuse and overdose," wrote the study authors.
According to the study, states that implemented comprehensive PDMP mandates saw a reduction in the opioid prescription rate from 161.47 to 147.07 per 1,000 Medicaid enrollees per quarter, a reduction in the opioid-related inpatient stay rate from 97.50 to 93.34 per 100,000 enrollees per quarter and a reduction in the opioid-related ED visit rate from 74.60 to 61.36 per 100,000 enrollees per quarter.
This represents an estimated annual reduction of approximately 12,000 inpatient stays and 39,000 ED visits, which could save over $155 million in Medicaid spending, according to the study.
"Our findings provide much-needed evidence to inform state policy discussions about strengthening and refining PDMPs to better tackle the opioid crisis," the study authors wrote.
One explanation for the overall reduction in opioid-related hospital use, according to the researchers? The use of these prescription drug databases helps promote referrals to opioid use disorder treatment. The information in the PDMPs helps providers more effectively identify high-risk people and creates an opportunity for intervention.