Loyola University Chicago

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Prescription drug monitoring reduces doctor shopping suggests research

Prescription drug monitoring reduces doctor shopping suggests research

"Anything that kills this many people merits strong attention from those with the ability to bring about a change," says Tim Classen, associate professor of economics.

By Whitney Critten| Student reporter

A new research study co-authored by Tim Classen, PhD, associate professor of economics, finds a strong correlation between the implementation of state managed prescription drug monitoring programs (PDMPs) and a reduction in doctor shopping for prescription opioid painkillers. The study was recently featured in Reuters and is forthcoming in the June 2017 edition of the Addictive Behaviors Journal.

Since joining Loyola in 2006, Classen has studied the economic causes and the consequences of adverse health behaviors such as obesity, suicide, and drug abuse. His current research examines whether state-based PDMPs are associated with a reduction in the abuse of prescription opioids. He is also studying whether PDMPs are responsible for the recent increase in heroin use due to the lack of access to prescription opioids— as people who are addicted to prescription opioids are 40 times more likely to use heroin.

Here, Classen discusses the study, its findings, and implications for further research.

Why study opioids and PDMPs?

In 2015, over 30,000 people died as a result of opioid overdoses— both prescription and street forms such as heroin, and since 2000, the overdose rate from opioids has more than tripled according to a 2016 study by the Centers for Disease Control and Prevention. Consequently, I feel that anything that kills this many people merits strong attention from those with the ability to bring about a change.

And so being aware of how pervasive the current opioid crisis is and how it has really devastated communities, I was interested in seeing whether PDMPs have the effect of mitigating or at least reducing, to some extent, the potential for the abuse of prescription opioids.

PDMPs are state-run electronic databases created to track the prescribing and dispensing of prescription drugs that are classified as controlled substances such as Dilaudid, Vicodin, OxyContin, and Percocet.

It’s important to note that not all physicians are as diligent as they should be when it comes to entering prescriptions into PDMP databases. This ultimately impacts the effectiveness of PDMPs as a public health and law enforcement tool.

What were your findings?

My co-authors and I hypothesized that if a link did exist between PDMPs and an overall reduction in the number of nonmedical prescription opioid users, PDMPs could be another public health tool for federal and state agencies to use in the current fight against prescription opioid abuse.

 For this study, we used data from the National Survey of Drug Abuse and Health from 2004-2014. The findings of the study are as follows:

  • PDMPs were found to have a significant effect on reducing the number of patients who engaged in doctor shopping— which is defined as seeing more than one medical provider for the sole purpose of obtaining multiple prescriptions.
  • PDMPs were found to have no effect on nonmedical use of prescription opioids that can lead to abuse, dependence, and initiation, but evidence suggests they are associated with a reduction in the number of days of opioid abuse in the past year.
  • PDMP implementation was not associated with an increase in heroin use or initiation, but was associated with an increase in number of days of heroin use in the past year. 

What are the implications for further research?

I think it would be interesting to research PDMPs as they continue to evolve. If I were to continue with this research, I would like to characterize the most beneficial features of the various state-level PDMPs, such as how frequently data should be collected in order to reduce prescription opioid abuse.

Currently, PDMPs are in every state except Missouri and function differently depending on the state and its guidelines on data collection and mandated reporting. I would look to Oklahoma as a model for PDMPs as the state happens to have a well designed data collection system.

I also think that it would be interesting to study street opioids such as heroin and illicitly made fentanyl as overdoses from these drugs are on the rise when compared to prescription opioids, which have begun to level off as of late.  

Obviously heroin is not within the scope of a pharmaceutical product, but the expanded availability and the demand for it, due to substantial decreases in the price of heroin, would be something to be studied. 

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