What Have We Learned From Evaluations of PDMP Programs?
What We Know
Though PDMPs are popular in both the criminal justice and medical fields, most of the evaluations of PDMPs focus on the implementation and effectiveness of PDMPs for medical reasons. In medicine, drug monitoring studies focus primarily on two approaches: electronic prescription systems and drug management systems and how they improve patient safety. In criminal justice, evaluations address a wide variety of questions including the impact of PDMPs on the types of prescription drugs abused, the availability of prescription drugs for abuse, whether physicians change the dosage or types of medications prescribed when a PDMP is established, which types of PDMPs are the most effective in reducing prescription drug abuse, costs and benefits associated with PDMPs, and how PDMPs are implemented.
Overall, it appears that PDMPs can be effective in reducing the supply of prescription drugs for inappropriate and illegal use. A national study of 15 states conducted by the General Accounting Office (GAO) noted that the existence of a PDMP in one state appeared to increase the diversion of prescription drugs in surrounding states without PDMPs. A more recent national study of all 50 states and the District of Columbia using multiple data sources identified differences in prescription drug abuse between states that are more proactive (search for possible cases of abuse when it seems warranted based on an analysis of the data) in investigations of potential abuse than reactive (initiate an investigation upon request by an outside party). States that are more proactive in regulating drugs that have a high potential for abuse but have a legitimate medical reason for use are more effective in reducing the possibility of prescription drug abuse than states that take a more reactive approach. Surveys of physicians using the PDMP have reported that it is helpful in reducing "doctor shopping" to obtain prescription drugs.
PDMPs have been shown to improve the speed of investigations of potential abuse, but there are concerns regarding the quality, timeliness, and use of data. Studies show that the effectiveness of PDMPs for impacting prescription drug abuse is related to ensuring that data are accurate and up-to-date and that users of the PDMP database perceive this to be the case.
In multiple states, underutilization of the PDMP database by physicians was reported as problematic for reasons related to both patient safety and identification of potential prescription drug abuse. A primary reason for underutilization appears to be a lack of awareness about the purpose of the PDMP. Therefore, providing more information about the program is proposed as a means to increase use by physicians.
Most evidence suggests that PDMPs have had little impact in regard to physicians changing their prescription practices. In one state survey of clinicians the PDMP did not appear to change practices; indicating that those in need of strong prescription drugs actually receive them. In another state survey of physicians only a small number of respondents indicated that being closely monitored by the PDMP has changed their prescribing practices in such a way that it has negatively impacted their ability to help patients with pain management.
What We Don't Know
There is limited evidence indicating that PDMPs are being used to help addicts receive substance abuse treatment and consequently reduce substance abuse. This lack of evidence is likely related to the fact that facilitating substance abuse treatment is not a common objective for PDMPs.
As states begin to share PDMP data it may have an effect on the diversion or illegal use of prescription drugs. Questions related to the impact of PDMP data sharing require evaluation.
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