Trends in Opioid Prescribing Following Statewide PDMP Implementation: The Pennsylvania Experience
CHAIM MILLER, BA
ASIF M. ILYAS, MD, MBA
Pennsylvania Prescription Drug Monitoring (PDMP) data showed a 33% decrease in the overall quantity of opioids prescribed between early 2017 to early in 2020.
The largest absolute decrease in prescriptions over this period was for Oxycodone and Hydrocodone, two of the most prescribed opioids in America.
Opioid prescriptions for longer than 7 days decreased significantly more than prescriptions for less than 7 days. A significant risk factor for opioid misuse and abuse is long-term opioid use.
From 1999 to 2017, almost 218,000 people have died from opioid-related overdoses, with more than 11 million people having misused prescription opioids in 2017 alone.1,2 Data from 2018 showed that approximately 128 people in the U.S. die every day from an opioid overdose.3 A prominent way states are tackling this crisis is by implementing a state-wide prescription drug monitoring program (PDMP). State PDMPs are electronic databases that collect and analyze patient prescription data on controlled substances and allow physicians the ability to access that information before prescribing. To date, all 50 states have implemented or are in the process of implementing a PDMP.5,6 Pennsylvania’s PDMP was established in August of 2016 and was mandated for use in specific situations on January 1st, 2017.7 Being a new PDMP, little research has been done on the effectiveness of this program and how it compares to other states. The aim of this research brief is to contribute to the growing knowledge about statewide PDMPs. The specific aim is to outline the three-year change in prescribing habits alongside the implementation of Pennsylvania’s PDMP.
Data pertaining to opioid prescribing habits as listed below were obtained from the Pennsylvania Department of Health (PA DOH) who administers the PDMP in Pennsylvania. As of January 1, 2017, all prescribers who are licensed, registered or otherwise lawfully authorized to distribute, dispense or administer a controlled substance, other drugs, or device in the course of professional practice or research in the Commonwealth are required to register with and query the PDMP in certain situations. Data provided by the PA DOH is categorized by quarters, each equaling 3 months of the year. Since the PA PDMP was implemented later in August of 2016, the fourth quarter of 2016 was ignored due to low-quality data, and the study analyses began from Q1 (Jan, Feb, Mar) 2017 through Q1 (Jan, Feb, Mar) 2020. Percent changes from the two timepoints were used for statistical analysis.
There was a 33% (677,194 absolute) decrease in the overall quantity of opioids prescribed from Q1 2017 through Q1 2020 (Figure 1). The largest absolute decrease in prescriptions was from Oxycodone (258,727 or 29%) and Hydrocodone (236,868 or 39%).
A closer look at the trends revealed a larger rate of decrease in opioids prescribed for more than 7 days compared to those prescribed for less than 7 days (43% vs 27%). Mirroring this finding, prescriptions for more than 22 pills at once saw an average rate of decrease of 37% in pills prescribed, against only a 21% decrease for 21 or fewer pills prescribed (figures 2-3).
This study depicted the changes in opioid prescribing habits from mid-2016 until early 2020, during the implementation of a statewide PDMP. Most interestingly, the highest rates of decrease during this period were from Oxycodone and Hydrocodone, two of the most frequently prescribed opioid medications. Also, longer-term opioid prescriptions decreased significantly more than short-term ones. This study shows promising trends in decreasing the number of opioids prescribed to patients that could lead to misuse and abuse.
U.S. Opioid Dispensing Rate Maps [Internet]. Centers for Disease Control and Prevention. Centers for Disease Control and Prevention; 2020 [cited 2021Feb10]. Available from: https://www.cdc.gov/drugoverdose/maps/rxrate-maps.html
McCance-Katz EF. [Internet]. The National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration; 2017 [cited 2021Feb10]. Available from: https://www.samhsa.gov/data/sites/default/files/nsduh-ppt-09-2018.pdf
National Institute on Drug Abuse. Opioid Overdose Crisis [Internet]. National Institute on Drug Abuse. 2020 [cited 2021Feb10]. Available from: https://www.drugabuse.gov/drug-topics/opioids/opioid-overdose-crisis
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Bao Y, Pan Y, Taylor A, Radakrishnan S, Luo F, Pincus HA, et al. Prescription Drug Monitoring Programs Are Associated With Sustained Reductions In Opioid Prescribing By Physicians. Health Affairs. 2016;35(6):1045–51.
Prescription Drug Monitoring Program. https://www.health.pa.gov/topics/programs/PDMP/Pages/