Since California updated its prescription drug monitoring program (PDMP) in 2016, adding the key features of automated proactive reports to prescribers and mandatory registration for prescribers and pharmacists, the current study evaluated the joint effect of these two PDMP features on county-level prescribing practices in California.
Using county-level quarterly data from 2012 to 2017, the study estimated the absolute change associated with the implementation of the two PDMP features in seven prescribing indicators in California compared to a control group of counties in Florida and Washington. The seven indicators were 1) opioid prescription rate per 1,000 residents; 2) patients’ mean daily opioid dosage in milligrams of morphine equivalents [MME]; 3) prescribers’ mean daily MME prescribed; 4) prescribers’ mean number of opioid prescriptions per day; 5) percentage of patients getting >90 MME/day; 6) percentage of days with overlapping prescriptions for opioids and benzodiazepines; and 7) multiple opioid provider episodes per 100,000 residents. Proactive reports and mandatory registration were associated with a 7.7 MME decrease in patients’ mean daily opioid dose (95 percent CI: -11.4, -2.9); a 1.8 decrease in the percentage of patients prescribed high-dose opioids (95 percent CI: -2.3, -0.9); and a 6.3 MME decrease in prescribers’ mean daily dose prescribed (95 percent CI: -10.0, -1.3). The study concluded that California’s implementation of these two PDMP features was associated with decreases in the total quantity of opioid MMEs prescribed and indicators of patients prescribed high-dose opioids compared to states that had PDMP’s without these features. Rates of opioid prescribing and other high-risk prescribing patterns remained unchanged. (publisher abstract modified)