There is a tool out there that could help save hundreds of lives lost to prescription painkiller overdoses. Doctors just need to start making better use of it, and states and hospital leaders alike need to help.
Prescription drug monitoring programs, or PDMPs, have been around for years, and now exist in every state except for Missouri. These databases allow doctors to see whether their patients are shopping around from hospital to hospital, attempting to get more pain pills like OxyContin or Vicodin to feed their addictions. But for various reasons — like the data being cumbersome to access, and not built into a doc’s normal workflow — PDMPs aren’t getting utilized to their full potential.
A new study out of Vanderbilt, released last week, further backs the notion that these databases could help to address the scourge of prescription painkiller abuse that killed more than 165,000 Americans between 1999 and 2014. If Missouri adopted its own PDMP, and every state enhanced its existing program, some 600 overdose deaths would be avoided annually, according to the study, published in the June issue of Health Affairs.
“I would encourage hospital leaders that PDMPs appear to be an effective tool to combat the rising prescription opioid epidemic,” Stephen Patrick, M.D., lead author of the study and an assistant professor of pediatrics and health policy at Vanderbilt, told me by phone. “As members of our community and as physicians and hospitals, it’s incumbent upon us to do our part to help limit the scope and reach of the prescription opioid epidemic.”
Researchers with Nashville-based Vanderbilt, and the Tennessee Department of Health, analyzed mortality data from 34 states with such programs between 1999 and 2013. They found that using such databases prevented about one opioid-related overdose death every two hours on average across the country. States that utilized more “robust” PDMPs — ones that monitored four or more drug schedules, for instance, and updated their data at least weekly — saw even greater reductions in OD deaths. Authors estimate, on average, that states with stronger programs saw reductions of 1.55 fewer deaths per 100,000 people compared to those without monitoring programs.
Dr. Patrick says movement is afoot in the industry to help bolster usability of PDMPs for docs, and ensure that more states deploy such robust approaches to tracking painkiller-prescribing patterns. The Centers for Disease Control and Prevention is investing money in PDMPs to help with that enhancement, and legislators are also considering related regulations on Capitol Hill.
Up next, Vanderbilt researchers plan to take a further look at the variability of different programs from state to state, and the effectiveness of mandating that providers use PDMPs, Patrick says. He’s also curious to see the impact of not having such a program in the state of Missouri. Absent of any other research, it’s clear that such databases are an important tool in turning the opioid overdose tide, but he emphasizes that they are just one small piece of an effective response, which should also include things like behavioral health and medication-assisted treatments.
“Prescription drug monitoring programs are one part of the solution, but they’re certainly not the only part of the solution,” Patrick says. “We need a public health approach that begins with thinking through primary prevention, improving access to treatment and looking at this as a health system overall, and I think hospitals are part of that public health solution.”
