Trends in Opioid Prescribing Following Statewide PDMP Implementation: The Pennsylvania Experience

2021 ◽  
Author(s):  
Chaim Miller ◽  
Asif Ilyas
Keyword(s):  
The United States ◽  
Prescribing Patterns ◽  
Prescription Data ◽  
Long Term Effects ◽  
Health Crisis ◽  
Opioid Prescribing ◽  
Average Decrease ◽  
The Third ◽  
Department Of Health ◽  
Prescription Drug Monitoring Programs

Abstract Background: The opioid epidemic is a major public health crisis in the United States. Legislators have enacted various strategies to combat this crisis, including the implementation of statewide prescription drug monitoring programs (PDMP). These PDMPs are electronic databases that collect and analyze patient prescription data on controlled substances allowing physicians to review prior prescriptions before prescribing. Objective: To determine opioid prescribing patterns after implementation of a statewide PDMP in Pennsylvania. Methods: After IRB approval, PDMP data was obtained from the Pennsylvania Department of Health. Data obtained included: drug name, days supplied, refill count, and partially filled prescriptions. The study timeline was 3 years, from first quarter 2017 through first quarter 2020.Results: Over the three years post implementation of a PDMP, Pennsylvania saw a 33% decrease in overall quantity of opioid pills prescribed (677,194 absolute), a 9% decrease in partially filled prescriptions (5,821 absolute), and an 18% decrease in the authorized refill (525 absolute). There also was a larger rate of decrease in prescriptions for more than seven days compared to prescriptions for less than seven days (43% vs 27%). However, the rate of decrease in opioid pills prescribed lessened from 14% in the first two years post implementation, to 10% from in the third year. The decrease in opioids partially filled for the first two years averaged 14% per year, while it increased by 23% in the third year. There also was an 8% average decrease in the rate of refills for opioids prescribed for the two years post implementation, while it was only 3% in the third year. Conclusion: There was a 33% decrease in overall quantity of opioid pills prescribed in the three years after the implementation of a PDMP. The first two years after implementation saw the largest decreases in prescribing habits, which slowed in the third year. More data is needed to show the long-term effects of implementing a statewide PDMP.

scholarly journals Opioid Prescribing Patterns by Drug Type: The Pennsylvania Experience

2021 ◽  
Author(s):  
Brock K. Bakewell ◽  
Chain Miller ◽  
Matthew Sherman ◽  
Asif M. Ilyas
Keyword(s):  
Monitoring Program ◽  
The United States ◽  
Prescribing Patterns ◽  
Public Health Issue ◽  
Cross Sectional ◽  
Opioid Prescribing ◽  
The Third ◽  
Department Of Health ◽  
Significant Public Health ◽  
Drug Type

Abstract Background: Opioid abuse persists as a significant public health issue in the United States; many states are implementing education and monitoring programs in response. This study examined opioid prescribing patterns and trends after implementing a prescription drug monitoring program in Pennsylvania from 2016 to 2020.Methods: A cross-sectional data analysis using de-identified data from Pennsylvania's PDMP delivered by the Pennsylvania Department of Health was undertaken.Results: In 2016, nearly 2 million opioid prescriptions were given to patients across the state. However, by the end of the study period in 2020, there was a 38% decrease in opioid prescriptions written. Specifically, over 700,000 fewer prescriptions in the first quarter of 2020 compared to the third quarter in 2016. The opioids that were most frequently prescribed were oxycodone, hydrocodone, and morphine.Conclusion: While fewer prescriptions were being prescribed overall, the breakdown of drug type being prescribed remained similar in 2020 compared to 2016. Fentanyl and hydrocodone saw the largest decrease between 2016 and 2020.

Unresolved Issues in Controlling the Tuberculosis Epidemic Among the Foreign-Born in the United States

1996 ◽  
Vol 22 (4) ◽  
pp. 503-536
Author(s):  
Guido S. Weber
Keyword(s):  
Public Health ◽  
The United States ◽  
Laboratory Research ◽  
Treatment Programs ◽  
State Governments ◽  
Foreign Born ◽  
Health Crisis ◽  
Department Of Health ◽  
Public Health Officials ◽  
Year 2000

Tuberculosis (TB), “the world’s most neglected health crisis,” has returned after decades of decline, but has only gradually caught the attention of governments as a formidable threat to public health. By 1984, when TB cases hit an all-time low, federal and state governments stopped supporting the medical infrastructure that once served to contain the disease. State officials around the nation began dismantling laboratory research programs and closing TB clinics and sanitoria. Since 1985, however, TB rates have steadily increased to 26,673 reported cases in 1992, and some have estimated that by the year 2000, there could be a twenty percent increase. By 1993, Congress, realizing that TB could pose a major public health threat, allocated over $100 million to the Department of Health and Human Services for TB prevention and treatment programs. Those funds, however, were sorely needed years before and amounted to only a fraction of what public health officials believe necessary to control TB today.

OpTrak

2020 ◽  
pp. 103-123
Author(s):  
Peng Zhang ◽  
Breck Stodghill ◽  
Cory Pitt ◽  
Cavin Briody ◽  
Douglas C. Schmidt ◽  
...  
Keyword(s):  
Integrated Approach ◽  
The United States ◽  
Prescription Data ◽  
Opioid Epidemic ◽  
Care Providers ◽  
Opioid Prescription ◽  
National Healthcare ◽  
Blockchain Technology ◽  
Prescription Drug Monitoring Programs ◽  
National Healthcare System

This article describes the structure and functionality of OpTrak, a decentralized app implemented using the Ethereum blockchain that targets the opioid epidemic currently plaguing the United States. Over-prescription and distribution of opioids cost the national healthcare system over $78 billion every year. Problems persist in every stage of the process, from doctors prescribing the medication to the pharmacists fulfilling prescriptions. These problems arise from a combination of factors, including lack of accountability, transparency, and reliability in the current prescription drug monitoring programs. This work provides three key contributions to research on a technical approach to mitigate the opioid epidemic. First, the authors pinpoint key problems in the current opioid prescription system. Second, they propose an integrated approach for addressing the problems by leveraging distributed ledgers, focusing on blockchain technology. Third, the authors describe the structure and functionality of OpTrak that allows a consortium of care providers to exchange patient prescription data securely.

scholarly journals Opioid Prescribing Mediating State Policy Intervention Effects on Drug Overdose Mortality

2021 ◽  
Author(s):  
Jacob James Rich ◽  
Robert Capodilupo
Keyword(s):  
Drug Overdose ◽  
The United States ◽  
Ordinary Least Squares ◽  
Sensitivity Analyses ◽  
Pain Reliever ◽  
Mediation Effects ◽  
Opioid Prescribing ◽  
Prescription Drug Monitoring Programs ◽  
Opioid Deaths ◽  
Overdose Deaths

The Centers for Disease Control and Prevention reported 70 630 drug overdose deaths for 2019 in the United States, 70.5% of which were opioid-related. Preliminary estimates now warn that drug overdose deaths likely surpassed 86 000 during 2020. Despite a 57.4% decrease in opioid prescribing since a peak in 2012, the opioid death rate has increased 105.8% through 2019, as the share of those deaths involving fentanyl increased from 16.4% to 72.9%. This letter seeks to determine whether the opioid prescribing and mortality paradox is robust to accepted methods of causal policy analysis and if prescribing rates mediate the effects of policy interventions on overdose deaths. Using loge-loge ordinary least squares with three different specifications as sensitivity analyses for all 50 states and Washington, DC for the period 2001-2019, the elasticities from the regressions with all control variables report operational prescription drug monitoring programs (PDMPs) reduce prescribing rates 8.7%, while mandatory PDMPs increase death rates from opioids 16.6%, heroin and fentanyl 19.0%, cocaine 17.3% and all drugs 10.5%. There is also weak evidence that recreational marijuana laws reduce prescribing, increases in prescribing increase pain reliever deaths, pill mill laws increase cocaine deaths, and medical marijuana laws increase total overdose deaths, with demographic variables suggesting states with more male, less non-Hispanic white, and older citizens experience more overdoses. Weak mediation effects were observed for pain reliever, cocaine, and illicit opioid deaths, while broad reductions in prescribing have failed to reduce opioid overdoses.

scholarly journals Reduction in Hospital System Opioid Prescribing for Acute Pain Through Default Prescription Preference Settings: Pre–Post Study

10.2196/24360 ◽  
2021 ◽  
Vol 23 (4) ◽  
pp. e24360
Author(s):  
Benjamin Heritier Slovis ◽  
Jeffrey M Riggio ◽  
Melanie Girondo ◽  
Cara Martino ◽  
Bracken Babula ◽  
...  
Keyword(s):  
The United States ◽  
Prescribing Patterns ◽  
Duration Of Treatment ◽  
Opioid Prescription ◽  
Hospital System ◽  
Opioid Prescribing ◽  
Before And After ◽  
Control And Prevention ◽  
Prescribing Practice ◽  
Quasi Experimental

Background The United States is in an opioid epidemic. Passive decision support in the electronic health record (EHR) through opioid prescription presets may aid in curbing opioid dependence. Objective The objective of this study is to determine whether modification of opioid prescribing presets in the EHR could change prescribing patterns for an entire hospital system. Methods We performed a quasi-experimental retrospective pre–post analysis of a 24-month period before and after modifications to our EHR’s opioid prescription presets to match Centers for Disease Control and Prevention guidelines. We included all opioid prescriptions prescribed at our institution for nonchronic pain. Our modifications to the EHR include (1) making duration of treatment for an opioid prescription mandatory, (2) adding a quick button for 3 days’ duration while removing others, and (3) setting the default quantity of all oral opioid formulations to 10 tablets. We examined the quantity in tablets, duration in days, and proportion of prescriptions greater than 90 morphine milligram equivalents/day for our hospital system, and compared these values before and after our intervention for effect. Results There were 78,246 prescriptions included in our study written on 30,975 unique patients. There was a significant reduction for all opioid prescriptions pre versus post in (1) the overall median quantity of tablets dispensed (54 [IQR 40-120] vs 42 [IQR 18-90]; P<.001), (2) median duration of treatment (10.5 days [IQR 5.0-30] vs 7.5 days [IQR 3.0-30]; P<.001), and (3) proportion of prescriptions greater than 90 morphine milligram equivalents/day (27.46% [10,704/38,976; 95% CI 27.02%-27.91%] vs 22.86% [8979/39,270; 95% CI 22.45%-23.28%]; P<.001). Conclusions Modifications of opioid prescribing presets in the EHR can improve prescribing practice patterns. Reducing duration and quantity of opioid prescriptions could reduce the risk of dependence and overdose.

Current Opioid Prescribing Patterns after Microdirect Laryngoscopy

2019 ◽  
Vol 129 (2) ◽  
pp. 142-148 ◽  
Author(s):  
Molly N. Huston ◽  
Rouya Kamizi ◽  
Tanya K. Meyer ◽  
Albert L. Merati ◽  
John Paul Giliberto
Keyword(s):  
The United States ◽  
Opioid Abuse ◽  
Prescribing Patterns ◽  
Opioid Analgesia ◽  
Opioid Use ◽  
Prescribing Practices ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Opioid Prescription ◽  
Opioid Prescribing

Background: The prevalence of opioid abuse has become epidemic in the United States. Microdirect laryngoscopy (MDL) is a common otolaryngological procedure, yet prescribing practices for opioids following this operation are not well characterized. Objective: To characterize current opioid-prescribing patterns among otolaryngologists performing MDL. Methods: A cross-sectional survey of otolaryngologists at a national laryngology meeting. Results: Fifty-eight of 205 physician registrants (response rate 28%) completed the survey. Fifty-nine percent of respondents were fellowship-trained in laryngology. Respondents performed an average of 13.3 MDLs per month. Thirty-four percent of surgeons prescribe opioids for over two-thirds of their MDLs, while only 7% of surgeons never prescribe opioids. Eighty-eight percent of surgeons prescribed a combination opioid and acetaminophen compound, hydrocodone being the most common opioid component. Many surgeons prescribe non-opioid analgesics as well, with 70% and 84% of surgeons recommending acetaminophen and ibuprofen after MDL respectively. When opioids were prescribed, patient preference, difficult exposure and history of opioid use were the most influential patient factors. Concerns of opioid abuse, the physician role in the opioid crisis, and literature about postoperative non-opioid analgesia were also underlying themes in influencing opioid prescription patterns after MDL. Conclusions: In this study, over 90% of practicing physicians surveyed are prescribing opioids after MDL, though many are also prescribing non-opioid analgesia as well. Further studies should be completed to investigate the needs of patients following MDL in order to allow physicians to selectively and appropriately prescribe opioid analgesia postoperatively.

scholarly journals The Role of the Medical School Training on Physician Opioid Prescribing Practices: Evidence from Ontario, Canada: Le rôle de la formation à la faculté de médecine à l’égard des pratiques de prescription d’opioïdes des médecins: données probantes d’Ontario, Canada

2020 ◽  
Vol 65 (10) ◽  
pp. 710-720
Author(s):  
Claire de Oliveira ◽  
Tomisin Iwajomo ◽  
Tara Gomes ◽  
Paul Kurdyak
Keyword(s):  
United States ◽  
Medical School ◽  
Medical Schools ◽  
The United States ◽  
Prescribing Patterns ◽  
Opioid Epidemic ◽  
Opioid Prescribing ◽  
Medical School Training ◽  
School Training

Background: Recent research found that physicians who completed medical school training at top-ranked U.S. medical schools prescribed fewer opioids than those trained at lower ranked schools, suggesting that physician training may play a role in the opioid epidemic. We replicated this analysis to understand whether this finding holds for Ontario, Canada. Methods: We used data on all opioid prescriptions written by Ontario physicians between 2013 and 2017 from the Narcotics Monitoring System. Using the Corporate Provider Database and ICES Physician Database, which contain medical school of training, we linked patients who filled opioid prescriptions with their respective prescribing physician. Available data on Canadian medical school rankings were obtained from Maclean’s news magazine. We used regression analysis to assess the relationship between number of opioid prescriptions and medical school ranking. Results: Compared to the United States, average annual number of opioid prescriptions per physician was lower in Ontario (236 vs. 78). Unlike the United States, we found little evidence that physicians trained at lower ranked medical schools prescribed more than their top-ranked school counterparts after controlling for specialty and location of practice. However, primary care physicians trained at non-English-speaking foreign schools prescribed the most opioids even after excluding opioid maintenance therapy–related prescriptions. Conclusion: The role of medical school training on opioid prescribing patterns among Ontario physicians differs from that in the United States likely due to greater homogeneity of curricula among Canadian schools. Ensuring physicians trained abroad receive additional pain management/addiction training may help address part of the opioid epidemic in Ontario.

Temporal trends in opioid prescribing patterns among oncologists in the Medicare population.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 12022-12022
Author(s):  
Vikram Jairam ◽  
Daniel X. Yang ◽  
Saamir Pasha ◽  
Pamela R. Soulos ◽  
Cary Philip Gross ◽  
...  
Keyword(s):  
New York ◽  
Negative Binomial ◽  
Temporal Trends ◽  
Negative Binomial Regression ◽  
The United States ◽  
Prescribing Patterns ◽  
Part D ◽  
Opioid Prescribing ◽  
Provider Characteristics ◽  
Final Study

12022 Background: In the wake of the United States (U.S.) opioid epidemic, there have been significant governmental and societal efforts to curb opioid prescribing. However, it is unknown whether these efforts have affected prescribing among oncologists, whose patient population often requires narcotics for symptom management. We investigated temporal patterns in opioid prescribing for Medicare patients among oncologists. Methods: We queried the Centers for Medicare and Medicaid Services Part D prescriber dataset to identify independently practicing physicians between January 1, 2013 and December 31, 2017. We used population-averaged multivariable negative binomial regression to estimate the association between time and per-provider opioid prescribing rate, defined as number of opioid claims (original prescriptions and refills) per 100 patients, among oncologists and non-oncologists on both a national and statewide level. All models were adjusted for provider characteristics and annual total patient count per provider. Results: The final study sample included 20,513 oncologists and 711,636 non-oncologists. From 2013 to 2017, the national opioid prescribing rate declined by 19.3% (68.8 to 55.5 opioid prescriptions per 100 patients; P< 0.001) among oncologists and 20.4% (50.7 to 40.3 prescriptions per 100 patients; P< 0.001) among non-oncologists. During this timeframe, 40 U.S. states experienced a significant ( P< 0.05) decrease in opioid prescribing among oncologists, most notably in Vermont (-43.2%), Idaho (-34.5%), and Maine (-32.8%). In comparison, all 50 states exhibited a significant decline ( P< 0.05) in opioid prescribing among non-oncologists. In 5 states, opioid prescribing decreased more among oncologists than non-oncologists, including Oklahoma (-24.6% vs. -7.1%), Idaho (-34.5% vs. -17.8%), Utah (-31.7% vs. -18.7%), Texas (-19.9% vs. -14.7%), and New York (-24.0% vs. -19.7%) (all P< 0.05). Conclusions: Between 2013 and 2017, the opioid prescribing rate decreased by approximately 20% nationwide among both oncologists and non-oncologists. These findings raise concerns about whether opioid prescribing legislation and guidelines intended for the non-cancer population are being applied inappropriately to patients with cancer and survivors.

Telehealth acceptability and opioid prescribing patterns of providers of painful chronic diseases during the COVID-19 pandemic: A survey of sickle cell providers

2021 ◽  
Vol 17 (6) ◽  
pp. 489-497
Author(s):  
Martha O. Kenney, MD ◽  
Benjamin Becerra, DrPH; MBA, MPH, MS ◽  
Sean Alexander Beatty, BA ◽  
Wally R. Smith, MD
Keyword(s):  
Chronic Diseases ◽  
Sickle Cell ◽  
Online Survey ◽  
Management Practices ◽  
Risk Mitigation ◽  
The United States ◽  
Prescribing Patterns ◽  
Prescribing Practices ◽  
Opioid Prescribing ◽  
The Impact

Objective: The coronavirus disease 2019 (COVID-19) has led to a rapid transition to telehealth services. It is unclear how subspecialists managing painful chronic diseases—such as sickle cell disease (SCD), an inherited hemoglobinopathy with significant disparities in access and outcomes—have viewed the transition to telehealth or altered their pain management practices. This study elicits the views of sickle cell providers regarding their transition to telehealth and their opioid prescribing patterns during the COVID-19 pandemic.Design: An anonymous online survey was sent to eligible sickle cell providers.Setting: Comprehensive sickle cell centers and/or clinics across the United States. Participants: Physicians and advanced practice providers providing care to SCD patients.Main outcome measures: Respondents answered questions regarding their (1) views of telehealth compared to in-person encounters and (2) opioid prescribing practices during the early months of the pandemic.Results: Of the 130 eligible participants, 53 respondents from 35 different sickle cell centers completed at least 90 percent of the survey. Respondents reported a significant increase in telehealth encounters for routine and acute appointments (mean difference and standard deviation: 57.6 ± 31.9 percent, p 0.001 and 24.4 ± 34.1 percent, p 0.001, respectively) since COVID-19. The overwhelming majority of respondents reported no changes in their opioid prescribing patterns since COVID-19, despite increased telehealth use. Only a minority coprescribed naloxone as a risk mitigation strategy.Conclusion: The rapid uptake of telehealth has not suppressed ambulatory providers’ prescribing of opioids for SCD. Studies assessing the impact of the COVID-19 pandemic and telehealth on opioid prescribing practices in other painful chronic diseases are needed to ensure health equity for vulnerable pain patients.

Sign in / Sign up

Export Citation Format

Share Document