Impact of prescription drug monitoring programs and pill mill laws on high-volume opioid prescribers: A comparative interrupted time series analysis
Prescription drug monitoring programs (PDMPs) and “pill mill” laws have been used to target risky opioid prescribing practices. A new CDC Injury Center study published in Drug and Alcohol Dependence evaluates the effect of these policy changes on high-volume prescribing behaviors among providers in Florida.
In the year following PDMP and policy implementation, decreases were seen among high-volume prescribers in the number of patients with an opioid prescription, monthly total opioid volume, average morphine equivalent dosage dispensed, and number of opioid prescriptions. Despite these decreases, opioid prescribing remained concentrated among high-volume prescribers, suggesting that payer/insurer initiatives and other policy changes that address risky prescribing practices are also needed to reduce opioid use, abuse and overdose.
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- Today’s Heroin Epidemic – More People at Risk, Multiple Drugs Abused
- Opioid Painkiller Prescribing - Where You Live Makes a Difference
- Prescription Painkiller Overdoses - A Growing Epidemic, Especially Among Women
- Use and Abuse of Methadone as a Painkiller
- Prescription Painkiller Overdoses in the US
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- Related page: State Data
- Centers for Disease Control and Prevention. Controlled Substance Prescribing Patterns — Prescription Behavior Surveillance System, Eight States, 2013. MMWR 2015; 64(SS09):1-14.
- Centers for Disease Control and Prevention. Demographic and Substance Use Trends Among Heroin Users — United States, 2002–2013. MMWR 2015; 64(26):719-725.
- Centers for Disease Control and Prevention. Decrease in Rate of Opioid Analgesic Overdose Deaths — Staten Island, New York City, 2011–2013. MMWR 2015; 64(18):491-494.
- Centers for Disease Control and Prevention. Increases in Heroin Overdose Deaths — 28 States, 2010 to 2012. MMWR 2014; 63: 849-854.
- Centers for Disease Control and Prevention. Decline in drug overdose deaths after state policy changes – Florida, 2010-2012. MMWR 2014; 63(26):569-574.
- Centers for Disease Control and Prevention. Alcohol Involvement in Opioid Pain Reliever and Benzodiazepine Drug Abuse–Related Emergency Department Visits and Drug-Related Deaths — United States, 2010. MMWR 2014; 63: 881-885.
- Centers for Disease Control and Prevention. Vital Signs: Variation Among States in Prescribing of Opioid Pain Relievers and Benzodiazepines — United States, 2012. MMWR 2014; 63(26);563-568.
- Centers for Disease Control and Prevention. Decline in Drug Overdose Deaths After State Policy Changes — Florida, 2010–2012. MMWR 2014; 63(26);569-574.
- Centers for Disease Control and Prevention. Vital Signs: Overdoses of Prescription Opioid Pain Relievers and Other Drugs Among Women — United States, 1999–2010. MMWR 2013; 62(26);537-542.
- Centers for Disease Control and Prevention. Vital Signs: Risk for Overdose from Methadone Used for Pain Relief — United States, 1999–2010. MMWR 2012; 61(26): 493-497.
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Addressing Prescription Drug Abuse in the United States: Current Activities and Future Opportunities [PDF - 1 MB]
Created by the Department of Health and Human Services’ Behavioral Health Coordinating Committee Subcommittee on Prescription Drug Abuse, this publication is a review of current federal initiatives and literature focused on ensuring the safe use of prescription drugs with the potential for abuse and the treatment of prescription drug dependence. The report includes identified opportunities to enhance programmatic and policy efforts as well as future research on prescription drug abuse and overdose in the U.S. (This publication was developed pursuant to Section 1122 of the Food and Drug Administration Safety and Innovation Act of 2012 (FDASIA).)
Policy Impact: Prescription Painkiller Overdoses [PDF - 1 MB]
Prescription Painkiller Overdoses is one in a series of issue briefs highlighting key public health issues and important, science-based policy actions that can be taken to address them. Through this publication, CDC supports state-based efforts to reduce prescription drug abuse while ensuring patients have access to safe, effective pain treatment. The publication includes information about deaths and emergency department visits resulting from prescription painkiller overdoses, overdose trends, the most common drugs involved, and the regions and populations most severely affected. Recommendations on how health care providers, private insurance providers, and state and federal agencies can work to prevent unintentional drug overdoses are also included.
Prescription Drug Overdose: State Health Agencies Respond [PDF - 1 MB]
To assess the knowledge, response, and planning regarding prescription drug misuse and overdose, in late 2007 the Association of State and Territorial Health Officials (ASTHO) and CDC conducted interviews with state and territorial health officials and other senior leaders in nine states (Arkansas, Florida, Indiana, Kentucky, Montana, North Carolina, Oklahoma, Utah, and West Virginia). The resulting report, Prescription Drug Overdose: State Health Agencies Respond, outlines the state perceptions, partnerships, recommendations, policies, and other issues that are fundamental to understanding and responding to drug misuse.
- NCHS. NCHS data on drug poisoning deaths. 2012. Available at: http://www.cdc.gov/nchs/data/factsheets/factsheet_drug_poisoning.html.
- Warner M, Chen LH, Makuc DM, Anderson RN, Miniño AM. Drug poisoning deaths in the United States, 1980-2008. NCHS data brief, no. 81. Hyattsville, MD: National Center for Health Statistics, 2011.
- Warner M, Chen LH, Makuc DM. Increase in fatal poisonings involving opioid analgesics in the United States, 1999–2006. NCHS data brief, no. 22. Hyattsville, MD: National Center for Health Statistics, 2009.
- Fingerhut LA. Increases in Poisoning and Methadone-Related Deaths: United States, 1999-2005. NCHS Health E-Stat. Hyattsville, MD: National Center for Health Statistics. 2008.
Guides and Meeting Reports
Prescription Drug Overdose Data & Statistics Guide to ICD-9-CM and ICD-10 Codes Related to Poisoning and Pain [PDF - 64 KB]
This guide provides a list of the International Classification of Disease (ICD) version 10 (ICD-10) and the ICD version 9 Clinical Modification (ICD-9-CM) codes for poisoning and pain. This list can be used to query databases featuring either morbidity (ICD-9-CM) or mortality (ICD-10) data.
Prescription Drug Overdose Data & Statistics Guide: CDC WONDER Multiple Causes of Death Dataset [PDF - 603 KB] This guide provides an overview of the steps to query Multiple Causes of Death data in CDC WONDER. CDC WONDER (Wide-ranging Online Data for Epidemiologic Research) is a data system that provides public-use data sets about mortality (deaths), cancer incidence, HIV and AIDS, tuberculosis, vaccinations, natality (births), census data and many other health outcomes. Multiple Causes of Death (MCOD) mortality data are based on death certificates for U.S. residents. Each death certificate contains underlying cause and up to twenty multiple causes of death and demographic data.
From Epi to Policy: Prescription Drug Overdose: State Health Department Training and Technical Assistance Meeting [PDF - 4 MB]
This report was prepared to summarize a meeting of health officials from 15 states funded to receive training on how to take what we know about the epidemic of Prescription Drug Overdose and turn it into effective action. The meeting sought to combine CDC’s research and epidemiology on prescription drug overdose with real-world discussions of the challenges and successes states have faced in confronting the epidemic. (Atlanta, Georgia, April 22-23, 2013)
Patient Review and Restriction Programs: Lessons learned from state Medicaid programs [PDF - 4 MB]
This report is a summary of an expert meeting to examine current practices of Patient Review and Restriction (PRR) programs and share insights about the operation of such programs to prevent prescription drug abuse, diversion, and overdose. (CDC Expert Panel Meeting Report, Atlanta, Georgia, August 27-28, 2012)
PBSS Data Briefs
Prescription Behavior Surveillance System Data Briefs
An analysis of Washington prescription drug monitoring program (PDMP) data revealed that multiple provider episodes (MPEs) vary by age group and class of prescription drug. Opioids and opioid combinations had the highest number of days of overlapping prescriptions, and eight opioids had a mean daily dosage greater than 120 morphine milligram equivalents (MME). Findings indicate that MPEs, overlapping prescription, and mean daily dosages over 100 MMEs are patient risk factors to look for in PDMP data.
Maine’s PDMP data was analyzed to examine several patient risk measures for prescription drug misuse, abuse and overdose. Patients aged 35-54 had the highest rate of MPEs, and opioids were the drug class most frequently involved with MPEs. However, the rate of MPEs declined from 2010 to 2014, and this coincided with an increase in prescribing of buprenorphine, widely used in treating opioid dependence.