States that require prescribers and dispensers to register with and use prescription drug monitoring programs saw notably fewer opioid prescriptions and reduced opioid-related hospital use compared to states with weak drug monitoring program mandates, according to a new study from investigators at Weill Cornell Medicine. The approximate annual reduction of about 12,000 inpatient stays and 39,000 emergency department visits could save an estimated $155 million a year in Medicaid spending.
Drug monitoring programs are statewide databases that collect and monitor prescribing and dispensing information of controlled prescription drugs to identify possible misuse by patients. All states and the District of Columbia, except Missouri, have implemented prescription drug monitoring plans to slow the opioid epidemic.
However, how these programs have been implemented has varied. Some states have comprehensive mandates that require all providers, regardless of practice setting, to register and use the program on initial prescribing and at least every 12 months after that for continuing prescriptions. Others have noncomprehensive mandates that only require registration, or have a weak use requirement, or both.
In the study, published Sept. 3 in Health Affairs, the researchers found that states with comprehensive mandates saw an 8.92 percent reduction in the number of opioid prescriptions, as well as 4.27 percent fewer hospital stays and 17.75 percent fewer emergency department visits related to opioid use. States with noncomprehensive mandates saw no reductions in these areas.
“Our findings contribute significant evidence in support of comprehensive mandates for reducing the use of opioid prescriptions by Medicaid patients, who have a much higher risk for opioid misuse and overdose compared to patients covered by other insurers,” said senior author Dr. Yuhua Bao, an associate professor of healthcare policy and research at Weill Cornell Medicine.
Dr. Yuhua Bao
The investigators used opioid prescription data reported by states to the Centers for Medicare and Medicaid Services and opioid-related hospital data from the Agency for Healthcare Research and Quality’s Healthcare Cost and Utilization Project. They analyzed data from the first quarter of 2011 through the last quarter of 2016.
In a previous study, Dr. Bao and colleagues found that states requiring prescribers to register with prescription drug monitoring programs saw a reduction in the number of prescriptions Schedule II opioids — drugs with a higher potential for abuse and overdose — by up to 10 percent among Medicaid enrollees. In the new study, which was conducted in collaboration with the University of Kentucky and Emory University, the reduction in opioid prescriptions also traced primarily to Schedule II opioids.
“This is the first study to examine the downstream effects of comprehensive prescription drug monitoring program mandates,” Dr. Bao said. “We hope our findings will inform state policy discussions for strengthening prescription drug monitoring programs to address the opioid crisis more effectively,” Dr. Bao said.
Dr. Bao and co-author Philip Jeng, also of Weill Cornell Medicine, were supported by a pilot grant from the Center for Health Economics of Treatment Interventions for Substance Use Disorder, HCV, and HIV (CHERISH), a National Institute on Drug Abuse Center of Excellence, Grant No. P30DA040500.