Study quantifies drug monitoring database’s effect on opioid prescriptions
■ A program in Canada shows the potential real-time reporting could have as U.S. systems move in that direction.
Real-time access to prescription drug monitoring program databases resulted in a sizable drop in the number of inappropriate prescriptions written for opioids and benzodiazepines in British Columbia, according to a study published online Sept. 4 in the Canadian Medical Assn. Journal (link).
A switch to real-time prescription drug monitoring programs — programs that log the prescription information into the system at the time it is written or filled — could have a similar effect on prescription drug monitoring programs in the United States, experts said. Nearly all states have or are planning databases that take in and distribute information about prescription patterns for controlled substances.
“Using the tool as a public health tool, and using it to help make treatment decisions, I think it’s helpful to have the information be as recent as possible,” said Sherry Green, CEO of the National Alliance for Model State Drug Laws. “Real time goes a long way toward, hopefully, increasing use of the [prescription monitoring program] as a public health tool. & I was really excited about the Canadian study, because it sort of suggests that that is a positive aspect of a program.” Green said the study comes at a time when several efforts are under way to switch delayed-reporting programs in the U.S. to real time.
Researchers from the University of British Columbia analyzed the number of inappropriate prescriptions written before and after the implementation of a real-time prescription drug monitoring program in 1995. They found that within 30 months postimplementation, inappropriate prescriptions for opioids and benzodiazepines fell 32.8% and 48.6%, respectively, for those on public assistance. For people 65 and older, there was a 40.1% reduction in inappropriate opioid prescriptions and a 42.4% reduction in inappropriate benzodiazepine prescriptions. The study was limited to these two groups because they were the only ones for whom researchers could get comparable before-and-after data.
Overall, the number of prescriptions deemed “inappropriate” were low before the system went live — 3.2% of opioid and 1.2% of benzodiazepine prescriptions filled by those receiving public assistance and 0.15% of opioid and 0.62% of benzodiazepine prescriptions filled by people 65 and older. But lead author Colin Dormuth, assistant professor in the Dept. of Anesthesiology, Pharmacology & Therapeutics at UBC, said the actual percentages are probably much higher.
The authors used a rigid definition for what was inappropriate, Dormuth said, likely excluding many prescriptions that were inappropriate but not included. The definition included any prescription for an opioid or benzodiazepine of 30 tablets or more filled by someone who had the same prescription issued by a different physician and filled at a different pharmacy within seven days.
“Even so, a conservative 1% absolute reduction in inappropriate prescriptions means that for every 100 patients prescribed an opioid, one patient was prevented from getting an inappropriate prescription,” Dormuth said.
The prescription drug monitoring program in British Columbia is similar to many programs in the U.S. that make use of the database by physicians optional. Pharmacists in British Columbia are required to use the system, although most pharmacists in the U.S. use the databases voluntarily. At the time of the study, physicians did not have access to the database, but Dormuth said about 2,000 of the 5,000 physicians eligible to use the system have since created an account.
The system in British Columbia was created for real-time reporting. In the U.S., 49 states have laws that create a prescription drug monitoring program, and 43 have a system up and running. Only Oklahoma is known to have real-time reporting, which went into use at the start of 2012.
Green said the biggest concern she hears from doctors considering use of the database is how recent the data are. Having real-time access is likely to result in wider physician use of the databases, she said.
Financial and logistical issues have prevented many states from moving forward with real-time access, but that is starting to change.
Programs in the U.S. have an average reporting time of seven days. Many started with 30-day reporting periods that have slowly been reduced during the past few years as technology became more advanced. More widespread use of electronic health records with e-prescribing and health information exchange capabilities will help make reporting to the databases occur in real time.
A few pilot programs in the U.S. are looking at the effectiveness of real-time access databases that are integrated into a physician’s EHR system.