Curb Drug Abuse

RX MONITORING PROGRAMS INEFFECTIVE IN CURBING DRUG ABUSE

Robert Twillman, PhD, immediate past-chair of the AACPI’s Advisory Council, head of the Kansas Pain Initiative, and program director of pain management at the University of Kansas Hospital, recently studied the effects of prescription monitoring programs (PMPs) on retail drug distribution patterns and measures of substance abuse. Twenty-two states currently have a system that tracks the prescribing of controlled substances.

Dr. Twillman presented his findings at the annual meeting of the American Pain Society earlier this month. His evaluation indicates that 1) states with PMPs, compared to those without PMPs, report less prescribing of most C-II opioids, especially morphine and oxycodone, while they report significantly greater prescribing of C-III opioids; and 2) states with PMPs do not report lower rates of abuse of prescription opioids, but in fact, actually report higher rates on one measure of such abuse.

When dividing states according to the type of PMP, those with PMPs that monitor both C-II and C-III opioids do not differ significantly from states with no PMPs in prescribing of any opioid except hydrocodone (with PMP states prescribing 68% more hydrocodone than states without PMPs). The pattern of findings with respect to drug abuse holds for these states. States that monitor only C-II opioids report significantly less prescribing of morphine, oxycodone, and hydrocodone, compared to states that monitor both C-II and C-III opioids.

This study suggests that PMPs are not effective in reducing drug abuse (and by extension, probably not effective in reducing drug diversion), and depending on the schedules monitored by the PMP, may result in "downscheduling" of medications prescribed to patients and in a sharp increase in prescribing of hydrocodone (which is the most commonly abused prescription opioid).

You can view Dr. Twillman’s presentation on the AACPI website at: http://aacpi.wisc.edu/policy.htm