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Study: Prescriptions for Opioids Stabilizing After Fivefold Increase Over 10 Years

Effectiveness of prescription drug monitoring programs varies by state

Death rates from opioids have been soaring in the U.S. since the 1990s. To support the appropriate use of these controlled substances and to inform public health interventions to prevent drug abuse, most states have implemented a prescription drug monitoring program (PDMP).

In a new study, researchers at Columbia University’s Mailman School of Public Health evaluated the impact of these state-wide programs and found that after tripling until 2007, annual rates of prescriptions for opioid analgesics have stabilized, although the effects of PDMPs on opioid dispensing vary markedly by state.

The new findings were published in the March/April issue of Public Health Reports.

Researchers used quarterly data on prescription opioids from the U.S. Drug Enforcement Administration’s Automation of Reports and Consolidated Orders System for the years 1999 to 2008 to analyze the impact of the program both nationally and at the state level. The data were then converted to morphine milligram equivalents (MMEs) for each state and the District of Columbia. The results were based on data for the seven most commonly prescribed opioid analgesics: fentanyl, hydrocodone, hydromorphone, meperidine, methadone, morphine, and oxycodone.

The study found that, from 1991 to 2010, the annual number of prescriptions for opioid analgesics in the U.S. almost tripled, from about 76 million to almost 210 million. Moreover, for the years 1998 to 2008, the annual MMEs per capita increased fivefold from 163 to 827. Until 2007, the annual number of MMEs dispensed per capita increased progressively before stabilizing.

Through 2008, state PDMPs had no discernible effect on the overall MMEs dispensed per capita. However, when the researchers examined data for individual states, they found that nine states recorded significantly fewer MMEs dispensed after implementing their PDMPs; 14 states reported no significant change; and eight states experienced significant increases in the MMEs dispensed.

Colorado had the greatest PDMP-associated decrease in MMEs (66.4%), followed by Texas (54%) and Wyoming (48%). The largest increase in MMEs (61%) was in Connecticut. Overall, the MMEs dispensed per capita were lower in the Midwest than in the Northeast.

“We found that PDMPs administered by state health departments appeared to be more effective than those administered by other government agencies, such as the bureau of narcotics and the board of pharmacy,” said senior author Guo-hua Li, MD, DrPH. Seven states with monitoring programs governed by a state department of health dispensed nearly 18% fewer MMEs than did states without the program.

“All age groups have been affected by the epidemic of prescription drug misuse, but the consequences of opioid analgesic misuse are particularly striking in adolescents and young adults,” said Joanne Brady, a PhD candidate in epidemiology.

“While state prescription drug monitoring programs have greatly expanded and rates of opioids dispensed are stabilizing, there exists considerable room to improve the overall effectiveness of state PDMPs, such as increasing interstate data sharing and making prescription drug-dispensing information accessible by health care providers in real time.”

Li stressed the importance of having access to information about the monitoring programs and their effect on the prescription rates for opioid analgesics. “The data can help guide additional research for identifying which characteristics of the state programs are effective and which are not, and can inform public policy for improving state prescription drug monitoring programs.”

Source: Columbia University; March 10, 2014.

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