Do Controlled Substance Databases Help or Hurt?

Written by Clay Smith

Spoon Feed
Prescription drug monitoring programs (PDMP) reduce opioid prescribing but may lead to an increase in illicit opiate use, especially in the absence of adequate opiate treatment resources.

Why does this matter?
Most states have PDMPs that track controlled substances prescribed. But as these have increased across the country, overdose deaths have also risen. They reduce opioid prescribing, but are they having an overall impact on the broader opioid epidemic?

Friend or folly (that’s a quaint title!)
Cons

  • Reducing opioid prescriptions without increasing opioid addiction treatment may have the unintended consequence of increasing illicit opiate use.

  • PDMPs may infringe on physician/clinician practice. Many are not user friendly and don’t integrate with the EMR.

  • Some are designed to support clinical decision making but also to support law enforcement in identifying problem patients and problem prescribers. Access for law enforcement varies state by state. Some advocate that law enforcement should only have individual access with probable cause.

  • Now, the bulk of overdose deaths are from illicit opiates, meaning the PDMP may have little impact on this.

Pros

  • PDMPs have drastically reduced unnecessary opioid prescribing.

  • Physician/clinician user experience is improving as is EMR integration in many places.

  • Integration of other non-pharmacy information, such as alerts that a patient has had previous non-fatal overdose could prove very helpful in future prescribing.

  • Clinicians can see co-prescribed controlled substances, such as benzodiazepines, known to increase the risk of overdose.

PDMPs are a tool and helpful when used as intended. They play a role in controlling the opioid epidemic. But we may see diminishing returns in reducing opioid deaths unless some changes are made to increase opiate treatment.

Source
Prescription Drug Monitoring Programs - Friend or Folly in Addressing the Opioid-Overdose Crisis? N Engl J Med. 2019 Aug 22;381(8):699-701. doi: 10.1056/NEJMp1904714.

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Reviewed by Thomas Davis

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