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In a state where there are more pain management clinics than McDonald’s restaurants, Florida seems to be the epicenter of the prescription pain killer addiction epidemic. From 2003-2009(1), the rate of fatalities from opiate overdose increased more than 80 percent in the state, and 90 of the 100 doctors purchasing the greatest number of oxycodone in the country were in Florida. Oxycodone is the opiate that has the greatest potential for being abused, and it's the most dangerous as it is as powerfully addictive as heroin.
In 2010, in response to the direness of the situation, Florida established laws requiring pain clinics to register with the state while subjecting them to increased surveillance. The next year, the Florida Prescription Drug Monitoring Program (PDMP), also known as E-FORSCE, became operational. This electronic database collects information about the dispensation of prescription drugs, which can be voluntarily accessed by prescribers. The ultimate goal is to prevent overprescribing and identifying patients who "doctor shop" – visiting multiple doctors to obtain multiple prescriptions.
Researchers from the Johns Hopkins University Bloomberg School of Public Health recently published their findings(2) in the journal Drug and Alcohol Dependence, which sought to assess the utility of this program with regard to high-risk prescribers.
Investigators used the IMS Health prescription database from July 2010 to September 2012 which they broke down into pre-intervention, intervention and post-intervention blocks. The data showed that high-risk prescribers accounted for 4 percent (1,526 doctors), yet 67 percent of total opioid volume (kilograms per month) and 40 percent of total opioid prescriptions.
Following the implementation of Florida’s laws, high-risk prescribers had significant reductions in numbers of opioid patients (-536 patients/month) and number of opioid prescriptions (-847 prescriptions per month). There were also drops in dose (measured morphine equivalent) and volume (kilograms per month).
No statistically significant changes were observed in low-risk prescribers.
“Our findings indicate how state policies such as PDMPs may reduce opioid use among the highest prescribers,” stated Hsien-Yen Chang, PhD, an assistant scientist in the Bloomberg School’s Department of Health Policy and Management, and the senior author of the study. “But our report also shows that programs like PDMPs must be complemented by many other measures to combat the epidemic of addiction and non-medical opioid use.”
The comparable prescription drug monitoring database (for controlled Schedule II, III, and IV drugs) in New York State is I-STOP and it is not voluntary. Just this year that state mandated the use of electronic prescriptions -- doing away with the prescription pad, which can be stolen and/or forged. It would be interesting to see whether these interventions will yield better results in curbing overprescribing and decreasing the morbidity and mortality of opioid addiction.
Prescription painkiller misuse and abuse is a profound public health problem. Trying to come up with an adequate solution will require much trial and error. Americans are the largest consumers, globally, of prescription opioids (and almost 100 percent of all hydrocodone and 81 percent of oxycodone) which highlights a profound problem. We need to shift the focus away from opiate analgesia where possible and continue to spread awareness of the potential consequences of prescription pain killer misuse to physicians and patients alike.
NOTES:
- JAMA Intern Med. 2015;175(10):1642-1649. doi:10.1001/jamainternmed.2015.3931
- Chang, H.-Y., et al., Impact of prescription drug monitoring programs and pill mill laws on high-risk opioid prescribers: A comparative interrupted time series analysis. Drug Alcohol Depend. (2016), http://dx.doi/10.1016/j.drugalcdep.2016.04.033
