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Unclear if prescription drug monitoring programs curb opioid overdoses

Evidence is lacking to determine whether the implementation of prescription drug monitoring programs aid in reducing fatal and nonfatal opioid overdoses, according to a study published in Annals of Internal Medicine.

“The overuse of prescription opioids during the past 2 decades has evolved into a major public health issue in the United States,” David S. Fink, MPH, from Columbia University and colleagues wrote.

“Prescription drug monitoring programs are a key component of the president's Prescription Drug Abuse Prevention Plan to prevent opioid overdoses in the United States,” they added.

Fink and colleagues assessed 17 studies to investigate whether prescription drug monitoring programs increase or reduce nonfatal and fatal overdoses, determine program features that are most effective and examine if such programs have unintended consequences.

Of the eligible studies, eight evaluated implementation of prescription drug monitoring programs only, two evaluated program features only, five evaluated both program implementation and features, one evaluated program implementation with mandated provider review and pain clinic law and one evaluated program robustness.

The researchers found insufficient evidence from three studies to determine the association between prescription drug monitoring programs and nonfatal overdoses. According to 10 studies with low-strength evidence, implementation of a prescription drug monitoring program was associated with a reduction in overdose deaths.

Program features that were most likely to reduce fatal overdoses included mandatory provider review, provider authorization to access program data, frequent update reports and monitoring of nonscheduled drugs, according to the researchers.

Three studies suggested that prescription drug monitoring program implementation was associated with an increase in heroin overdoses.

“We conclude that variations in [prescription drug monitoring program] features are likely to affect outcomes differently,” they wrote. “A [prescription drug monitoring program’s] ability to influence population health probably arises from its unique set of administrative features. Future studies will have to consider this variation in features to develop a set of empirically based best practices that result in the greatest reduction in prescription opioid–related harm and mitigate any potential unintended consequences of [prescription drug monitoring programs], such as heroin-related harms.”

In an accompanying editorial, Wilson M. Compton, MD, MPE, and Eric M. Wargo, PhD, both from the National Institute on Drug Abuse, wrote that the study by Fink and colleagues should serve as a reminder that prescription drug monitoring programs is not the whole solution but part of a wide range of interventions to address the opioid epidemic.

“Additional approaches include interventions, such as provider education, to reduce opioid overprescribing; expanded access to drug treatment; primary prevention; and naloxone distribution,” they wrote. “We hope that further research will illuminate how [prescription drug monitoring programs] fit into this larger picture of efforts to stop the opioid crisis.” – by Alaina Tedesco

Disclosure: Fink reports receiving grants from NIH. Please see study for all other authors’ relevant financial disclosures. Wargo reports no relevant financial disclosures. Compton reports having long-term stock holdings in General Electric Co., Pfizer Inc. and 3M Companies.