PDMP & Data Surveillance
Many prescription drug monitoring programs (PDMPs) send electronic alerts to prescribers when a patient exceeds one or more risk indicator thresholds, such as high average daily opioid dosage or overlapping opioid and benzodiazepine prescriptions. Little is known, however, about patient prescription behavior in the period prior to exceeding a threshold; subsequent to exceeding a threshold in the absence of alerts; or to what extent different indicators are capturing the same patients.
This session will present research findings from three linked studies, which can inform more targeted and timely interventions to prevent overdose deaths. First, using de-identified PDMP data from three states that do not issue alerts, researchers selected patients who exceeded one or more of five opioid-related risk thresholds during at least one month in an index year. Researchers then examined their monthly prescription behavior for the 36 months from January of the year prior through December of the year subsequent to the index year. Latent class analyses revealed four distinct typical trajectories for each indicator, which were strikingly similar across the states. There was little overlap in trajectory group membership between the different indicators. Second, in one of these states, Ohio, researchers then assessed the association between trajectory group membership for 2012-2014 and overdose death in 2014-2015 and in 2015 only. Drugs contributing to each death, including prescription and illicit opioids, were identified. Membership in each of the four trajectory groups, for each risk indicator, carried substantially different risk for subsequent overdose deaths. In particular, membership in one trajectory group for high average daily opioid dosage was associated with two to three times the risk of death involving heroin or fentanyl than membership in the other groups. Membership in a second group conferred a similarly heightened risk of prescription opioid-related death. Finally, also using data from Ohio, a third study assessed risk of overdose death associated with exceeding any one, two, three, four, or all five risk indicators examined. Each indicator captured a largely different group of patients; risk of overdose death increased approximately linearly with each additional indicator exceeded.
This session is accredited for the following accreditation types: CME, CNE, CPE, APA, AAFP, AAHCPAD*, NAADAC*, ASWB,* GA Post.
*State and provincial regulatory boards have the final authority to determine whether an individual course may be accepted for continuing education credit.