Prescription monitoring programs can lead to illicit drug use: Studies

Researchers culled academic literature on prescription drug monitoring programs to gauge whether such programs have an effect on opioid overdoses and found that three studies showed an increase in heroin overdose deaths after the monitoring programs had been implemented, according to a statement issued Monday by the Columbia University Mailman School of Public Health.

For the investigation into PDMPs researchers at New York’s Columbia University and the University of California in Davis, California analyzed 2,661 articles, 10 of which linked the implementing of prescription registries to reducing fatal opioid overdoses, with three noting that heroin use ensued when a person was cut off opioid prescriptions. The findings were published online in Annals of Internal Medicine.

PDMPs utilize centralized statewide data systems to transmit prescription data, which can flag patients who are potentially abusing opioids or physicians who are overprescribing, researchers noted. All 50 states either have an PDMP in place or are in the process of passing bills that would create one, according to researchers. A national PDMP is also in the works, per President Donald Trump’s plan to combat opioid abuse and deaths.

“Our aim was to systematically search and review the literature to assess whether these programs are associated with changes in nonfatal or fatal overdoses,” said lead author David Fink, a doctoral candidate in epidemiology at the Mailman School of Public Health, in a statement. “The evaluations would also help us determine whether specific administrative features of PDMPs correlate with these outcomes and, if so, which elements are most influential … the definitive conclusion we can draw from our evaluation is that the evidence is insufficient and that much more research is needed to identify a set of best practices.” 

“(The findings) suggested to us that heroin substitution may have increased after PDMP-inspired restrictions on opioid prescribing,” said co-author Silvia Martins, an associate professor of epidemiology at Columbia. “We therefore caution that programs aimed at reducing prescription opioids should also address the supply and demand of illicit opioids.”

Opioid prescribing has increased 350% between 1999 and 2015, researchers noted. During the same timeframe, the rate of overdose deaths from both prescription opioids and heroin also increased substantially.