Can Mandatory Consultation of a State PDMP Reduce Overdose Morbidity? Maybe.
Every state now has a prescription drug monitoring program (PDMP) in place to record prescriptions of controlled substances, but they vary widely in the information they collect and whether and how physicians must consult the database. Beginning in 2013, New York instituted mandatory consultation for physicians: before they prescribe an opioid to a patient, they are required to consult the state PDMP database to determine if the patient may be at risk for abusing the prescription.
To explore the effectiveness of the system (called I-STOP, for “Internet System for Tracking Over-Prescribing”), researchers at Bassett Healthcare Network in Cooperstown, NY, examined prescription trends and opioid-related mortality before and after the implementation of I-STOP.
They found that while the number of opioid prescriptions declined after implementation, the total quantity of opioids in the supply chain increased. Hospital and emergency department visits for prescription opioid overdose were not significantly affected by the program, and visits for heroin overdose, which began to increase in 2010, continued to rise through 2016.
Despite not decreasing opioid-related morbidity, the program may nonetheless have prevented it from increasing. The authors concluded: “The overall significance of these findings shows a small impact of PDMPs on prescription opioid overdose morbidity in New York in the context of the increasing national trend during this time period.”
Brown R, Riley MR, Ulrich L, Kraly EP, Jenkins P, Krupa NL, Gadomski A. Impact of New York prescription drug monitoring program, I-STOP, on statewide overdose morbidity. Drug Alcohol Depend. 2017 Sep 1;178:348-354.