Drug Monitoring Program Records Significant Drop in Painkiller Prescriptions

OxycodoneIn the past year, the number of narcotic painkillers prescribed in New Hampshire decreased by more than 13 percent, while cases of suspected “doctor shopping” by patients dropped by nearly two-thirds.

The new data, presented to Gov. Maggie Hassan and legislative leaders earlier this month, suggest that two years after it was launched, the state’s Prescription Drug Monitoring Program is working as designed.

Michelle Ricco Jonas, the PDMP’s program manager, said the numbers show the system has changed how doctors and nurses prescribe opioids, as well as how patients use them.

Painkiller Rx_1

Prescribed doses of opioids have decreased significantly in the past 18 months.
CREDIT SARA PLOURDE

“This is showing us that the number of people seeing multiple providers and getting prescriptions filled at multiple pharmacies is decreasing,” she said. “This is something we want to see and hope to see it further decrease with the increased utility of the program.”

New Hampshire was the 49th state to authorize a program to monitor prescriptions for drugs that carry a risk of abuse. Schedule II drugs – especially opioid pain medications such as oxycodone and morphine – are the most frequently abused. Experts say years of indiscriminate prescribing of these drugs is directly linked to the state’s heroin crisis.

The PDMP went online in September 2014. In its first full year, at least 50.5 million doses of opioid pain relievers were dispensed.

That estimate is on the low end – for much of that period, the information was retained for just three months. A recent change in the law required it be kept for three years, allowing for a fuller picture of the program’s impact.

County Controlled Rx

Nearly a half-million people – about 34 percent of NH’s population – were prescribed controlled substances in FY 2016.
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From October through December 2015 – the first quarter of FY 2016 – some 12.4 million pain killers were dispensed. In the fourth quarter, that dropped to just over 10.7 million doses, a 13 percent decrease.

The decline in patients whose behavior suggested “doctor shopping” – using at least five prescribers and pharmacies to obtain opioids – was even more pronounced. In 2015, the PDMP flagged an average of nine patients a month who obtained prescriptions from multiple sources; that number dropped to three patients per month in the most recent fiscal year.

Use of the program by prescribers is also increasing: doctors and nurses queried the PDMP more than 300,000 times in fiscal year 2016.

But not all the news is good. The most dangerous drugs – opioids – still account for four of every 10 controlled substance dispensed in New Hampshire. Moreover, one in three residents – almost 500,000 people – received at least one prescription for a drug with the potential for abuse.

The PDMP is only one way lawmakers are trying to get their arms around a problem that killed more than 430 people in 2015.

The strategy, which includes millions in new funding for prevention, treatment and law enforcement, will likely take time to work: New Hampshire is on track to record 500 or more drug overdose deaths this year.

— Brian Wallstin, New Hampshire Public Radio

Follow Prescription Advisory

Although relieving pain and reducing suffering are primary emergency physician responsibilities, there is a concurrent duty to limit the personal and societal harm that can result from prescription drug misuse and abuse.

Pain Management / Clinical PolicyACEP Annals of Emergency Medicine 525, October 2012

Whenever possible, orthopaedic surgeons should request and review old medical records and speak with the patient’s primary physician about past medication problems. Currently, states have Prescription Drug Monitoring Programs designed to assist law enforcement in the identification of doctor shoppers; these data are also accessible to physicians.

American Academy of Orthopaedic Surgeons, Now, March 2014

Rick Bunker is a co-founder, and the CEO of Prescription Advisory Systems and Technology (P.A.S.T.). In this role, he is responsible for capital formation and corporate development.

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