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Impact of prescription drug monitoring programs (PDMPs) on opioid utilization among Medicare beneficiaries in 10 US States.
Addiction. 2017 Oct; 112(10):1784-1796.A

Abstract

BACKGROUND AND AIMS

Prescription Drug Monitoring Programs (PDMPs) are a principal strategy used in the United States to address prescription drug abuse. We (1) compared opioid use pre- and post-PDMP implementation and (2) estimated differences of PDMP impact by reason for Medicare eligibility and plan type.

DESIGN

Analysis of opioid prescription claims in US states that implemented PDMPs relative to non-PDMP states during 2007-12.

SETTING

Florida, Louisiana, Nebraska, New Jersey, Vermont, Georgia, Wisconsin, Maryland, New Hampshire and Arkansas, USA.

PARTICIPANTS

A total of 310 105 disabled and older adult Medicare enrolees.

MEASUREMENTS

Primary outcomes were monthly total opioid volume, mean daily morphine milligram equivalent (MME) dose per prescription and number of opioid prescriptions dispensed. The key predictors were PDMP status and time. Tests for moderation examined PDMP impact by Medicare eligibility (disability versus age) and drug plan [privately provided Medicare Advantage (MAPD) versus fee-for-service (PDP)].

FINDINGS

Overall, PDMP implementation was associated with reduced opioid volume [-2.36 kg/month, 95% confidence interval (CI) = -3.44, -1.28] and no changes in mean MMEs or opioid prescriptions 12 months after implementation compared with non-PDMP states. We found evidence of strong moderation effects. In PDMP states, estimated monthly opioid volumes decreased 1.67 kg (95% CI = -2.38, -0.96) and 0.75 kg (95% CI = -1.32, -0.18) among disabled and older adults, respectively, and 1.2 kg, regardless of plan type. MME reductions were 3.73 mg/prescription (95% CI = -6.22, -1.24) in disabled and 3.02 mg/prescription (95% CI = -3.86, -2.18) in MAPD beneficiaries, but there were no changes in older adults and PDP beneficiaries. Dispensed prescriptions increased 259/month (95% CI = 39, 479) among the disabled and decreased 610/month (95% CI = -953, -257) among MAPD beneficiaries.

CONCLUSIONS

Prescription drug monitoring programs (PDMPs) are associated with reductions in opioid use, measured by volume, among disabled and older adult Medicare beneficiaries in the United States compared with states that do not have PDMPs. PDMP impact on daily doses and daily prescriptions varied by reason for eligibility and plan type. These findings cannot be generalized beyond the 10 US states studied.

Authors+Show Affiliations

Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA.Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA.RAND Center for Causal Inference, RAND Corporation, Santa Monica, CA, USA.Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA.University of Maryland School of Social Work, Baltimore, MD, USA.Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. Center for Drug Safety and Effectiveness, Johns Hopkins University, Baltimore, MD, USA. Division of General Internal Medicine, Department of Medicine, Johns Hopkins Medicine, Baltimore, MD, USA.Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28498498

Citation

Moyo, Patience, et al. "Impact of Prescription Drug Monitoring Programs (PDMPs) On Opioid Utilization Among Medicare Beneficiaries in 10 US States." Addiction (Abingdon, England), vol. 112, no. 10, 2017, pp. 1784-1796.
Moyo P, Simoni-Wastila L, Griffin BA, et al. Impact of prescription drug monitoring programs (PDMPs) on opioid utilization among Medicare beneficiaries in 10 US States. Addiction. 2017;112(10):1784-1796.
Moyo, P., Simoni-Wastila, L., Griffin, B. A., Onukwugha, E., Harrington, D., Alexander, G. C., & Palumbo, F. (2017). Impact of prescription drug monitoring programs (PDMPs) on opioid utilization among Medicare beneficiaries in 10 US States. Addiction (Abingdon, England), 112(10), 1784-1796. https://doi.org/10.1111/add.13860
Moyo P, et al. Impact of Prescription Drug Monitoring Programs (PDMPs) On Opioid Utilization Among Medicare Beneficiaries in 10 US States. Addiction. 2017;112(10):1784-1796. PubMed PMID: 28498498.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of prescription drug monitoring programs (PDMPs) on opioid utilization among Medicare beneficiaries in 10 US States. AU - Moyo,Patience, AU - Simoni-Wastila,Linda, AU - Griffin,Beth Ann, AU - Onukwugha,Eberechukwu, AU - Harrington,Donna, AU - Alexander,G Caleb, AU - Palumbo,Francis, Y1 - 2017/06/27/ PY - 2016/07/08/received PY - 2016/10/31/revised PY - 2017/05/05/accepted PY - 2017/5/13/pubmed PY - 2018/6/2/medline PY - 2017/5/13/entrez KW - Controlled substance monitoring KW - Medicare KW - drug policy KW - drug utilization KW - interrupted time-series KW - observational study KW - opioid use KW - prescription drug monitoring programs KW - prescription opioids SP - 1784 EP - 1796 JF - Addiction (Abingdon, England) JO - Addiction VL - 112 IS - 10 N2 - BACKGROUND AND AIMS: Prescription Drug Monitoring Programs (PDMPs) are a principal strategy used in the United States to address prescription drug abuse. We (1) compared opioid use pre- and post-PDMP implementation and (2) estimated differences of PDMP impact by reason for Medicare eligibility and plan type. DESIGN: Analysis of opioid prescription claims in US states that implemented PDMPs relative to non-PDMP states during 2007-12. SETTING: Florida, Louisiana, Nebraska, New Jersey, Vermont, Georgia, Wisconsin, Maryland, New Hampshire and Arkansas, USA. PARTICIPANTS: A total of 310 105 disabled and older adult Medicare enrolees. MEASUREMENTS: Primary outcomes were monthly total opioid volume, mean daily morphine milligram equivalent (MME) dose per prescription and number of opioid prescriptions dispensed. The key predictors were PDMP status and time. Tests for moderation examined PDMP impact by Medicare eligibility (disability versus age) and drug plan [privately provided Medicare Advantage (MAPD) versus fee-for-service (PDP)]. FINDINGS: Overall, PDMP implementation was associated with reduced opioid volume [-2.36 kg/month, 95% confidence interval (CI) = -3.44, -1.28] and no changes in mean MMEs or opioid prescriptions 12 months after implementation compared with non-PDMP states. We found evidence of strong moderation effects. In PDMP states, estimated monthly opioid volumes decreased 1.67 kg (95% CI = -2.38, -0.96) and 0.75 kg (95% CI = -1.32, -0.18) among disabled and older adults, respectively, and 1.2 kg, regardless of plan type. MME reductions were 3.73 mg/prescription (95% CI = -6.22, -1.24) in disabled and 3.02 mg/prescription (95% CI = -3.86, -2.18) in MAPD beneficiaries, but there were no changes in older adults and PDP beneficiaries. Dispensed prescriptions increased 259/month (95% CI = 39, 479) among the disabled and decreased 610/month (95% CI = -953, -257) among MAPD beneficiaries. CONCLUSIONS: Prescription drug monitoring programs (PDMPs) are associated with reductions in opioid use, measured by volume, among disabled and older adult Medicare beneficiaries in the United States compared with states that do not have PDMPs. PDMP impact on daily doses and daily prescriptions varied by reason for eligibility and plan type. These findings cannot be generalized beyond the 10 US states studied. SN - 1360-0443 UR - https://www.unboundmedicine.com/medline/citation/28498498/Impact_of_prescription_drug_monitoring_programs__PDMPs__on_opioid_utilization_among_Medicare_beneficiaries_in_10_US_States_ L2 - https://doi.org/10.1111/add.13860 DB - PRIME DP - Unbound Medicine ER -