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“Doctor Shopping” for Opioids Reduced in States With Prescription Drug Monitoring

March 10, 2017

Persons seeking opioid prescriptions for nonmedical uses more rarely received the drugs from multiple physicians following implementation of state-run prescription drug monitoring programs, or PDMPs, according to a recent study.

The data, which was published in Addictive Behaviors, also suggests that PDMP implementation did not affect the initiation or abuse of nonmedical opioids, but did reduce the number of days of opioid misuse within the previous year.

“PDMPs are state-run electronic databases designed to track prescribing and dispensing of prescription drugs classified as controlled substances,” Mir M Ali, PhD, of the Center for Behavioral Health Statistics and Quality, and colleagues wrote. “These databases are intended not only to reduce over-prescribing of pain medications by doctors but also to identify individuals at high risk for opioid use disorder, such as individuals with opioid prescriptions from multiple providers.”

PDMPs are operated in every state but Missouri, although participation is not mandatory in certain states. Although prior studies on the programs have demonstrated conflicting results, Dr Ali and colleagues wrote, none have examined the role of PDMPs on individual level opioid-related outcomes.
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To do so, the researchers examined data from the National Survey of Drug Use and Health collected from 2004-2014. They compared the initiation of 36 states’ PDMPs to various changes in state-level trends, including prescription opioid misuse, heroin abuse, and the source of prescription opioid misuse.

They found that although PDMP initiation was not associated with past-year use, dependence or abuse of nonmedical prescription opioids, it did appear to reduce the number of days of past-year use. Implementation also had little effect on past-year heroin use and initiation, but was associated with an increase in past-year days of use in states without mandatory PDMP access and enrollment.

PDMP implementation was associated with reduced receipt of pain relievers for nonmedical use from multiple doctors both in states with mandatory access (80% reduction; P < .05) or without mandatory access (56% reduction; P < .05). Despite this trend, there was no evidence of increasing reliance on illegal or social acquisition of opioids. —Dave Muoio

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