Compared to doing nothing, yes.
Prescription Drug Monitoring Programs (PDMPs – also called Prescription Monitoring Programs, PMPs) are a core strategy in the states’ and federal government’s battle to reverse the growth of the opioid abuse epidemic.
But, in the clinic and among orthopedic physicians and their patients, are they working?
Given the massive effort—every state and the District of Columbia now has one, as do the Department of Defense (DOD) and the Veterans Health Administration (VHA)—results so far are weak.
One National System or a Patchwork of State Programs?
In order for the array of PDMPs to be really effective, a single national system is probably needed. However, before that can happen, anyone advocating a national system will have to win a series of major turf battles with the states and DOD.
As of the date of this article (things are fluid), prescribers in 26 of the 51 states (including D.C.) were required to use PDMPs to check a patient’s other prescriptions to thwart “doctor-shopping” by patients seeking opioids. In 25 others, PDMP use was voluntary (the ratio changes as more states go mandatory).
Many of these state databases have been around for years (since 1939 in California, 1972 in Pennsylvania), but most were implemented between 2001 and 2012.
In Missouri, which had been the last holdout state until 2017, Gov. Eric Greitens, frustrated by the state legislature’s repeated failures to authorize a PDMP by law, created one by executive fiat. It began operating December 9, 2017.
Do Prescription Drug Monitoring Programs Work?
The logic behind PDMPs is that their increased use by physicians, and monitoring of the data by both law enforcement and federal health officials in the background, will reduce prescribing, illegal use, diversion of opioids, and both non-fatal and fatal incidents.
So how are they working?
“Extant evidence for the impact of PDMPs as an opioid risk mitigation tool remains mixed,” says a 2017 study, “Evaluating the impact of prescription drug monitoring program implementation: a scoping review.” (BMC Health Serv Res. 2017 Jun 20;17(1):420. doi: 10.1186/s12913-017-2354-5.)
That’s an oblique way of saying their impacts are few, limited, and in some cases, negative—and maybe the federal government really can’t tell.
That study didn’t take law enforcement into account. It’s likely that PDMPs are helping federal, state, and local drug cops to chase down “pill mill” physicians and pharmacies because drug cops can snoop on over-prescribing—right down to the individual physician and pharmacy.
Yet, while the total number of prescriptions is down 22% since 2012, the epidemic of opioid use disorder (OUD) and opioid deaths has worsened each year since 2012, according to CDC data. Hospital visits for drug overdoses: they’ve soared. Deaths: soared. Use of heroin: soared. Use of illegal fentanyl: soared.
The study cited above concludes that there’s a correlation between implementation of a PDMP and fewer prescriptions in some states, but not in others.
