The Effectiveness of Prescription Drug Monitoring Programs and Interventions for the Opioid Epidemic

Many people assume that since the launch of Prescription Drug Monitoring Programs (PDMP), the issue of the opioid epidemic is being overcome by the implementation of these government official regulated programs. Prescription Drug Monitoring Programs are designed monitor prescribing and dispensing data electronically by collecting data from pharmacies and dispensing practitioners (The PDMP Training and Technical Assistance Center).

Today I argue to you citizens of Orlando and readers of the Orlando Sentinel, that while I agree that there has been some improvement in opioid abuse and overdose deaths, I believe we need to reassess whether or not Prescription Drug Monitoring Programs are the answer to the opioid epidemic. Do PDMPs address the root of the problem, which is addiction? Is this really the best we can do to address such a horrifying ordeal present in our society today? Essentially, I am arguing not that Prescription Drug Monitoring Programs are not at all effective, but that they do not fully address the opioid epidemic because they do not encompass the issue of addiction, and therefore, they are not the most effective way to battle the opioid abuse problems seen in the United States.

Ultimately what is at stake here is the lives and well being of the American people. I would say almost all Americans have been affected in some way by this epidemic whether they are directly affected as a addict, a family member watching their loved one slowly incapacitate themselves daily as they slip deeper into the black hole of addiction, healthcare providers or pharmacists that watch as they continually seek narcotics, law makers and politicians that are worried about the welfare of others, or even the pharmaceutical companies that could be concerned about the poor publicity of the drugs they are creating. By focusing on monitoring inappropriate opioid distribution, I believe we, as the American people, have overlooked the substantial problem of opioid addiction. Therefore, I claim that although they have had some success, Prescription Drug Monitoring Programs are not the most effective way to address the issue, as evidence by the many Americans that remain addicted to opioids, an insurmountable amount of overdose deaths, and the continued strive by large organizations to find a better approach.

The Opioid Epidemic is one that has been prevalent since the 1990s, which has escalated and caused many issues within the United States. According to the National Institute on Drug Abuse, Opioid Overdose Crisis, pharmaceutical companies encouraged the beginning of the opioid epidemic when they “reassured the medical community that patients would not become addicted to prescription opioid pain relievers, and healthcare providers began to prescribe them at greater rates” (National Institute on Drug Abuse). The medical community may have been under the impression that they were helping their patients by prescribing these stronger pain medications, however, the National Institute on Drug Abuse states that by 2015 “an estimated 2 million people in the United States suffered from substance use disorders related to prescription opioid pain relievers” (National Institute on Drug Abuse). These statistics challenged the pharmaceutical companies claims that opioids did not have addictive characteristics. The epidemic then began to spark the interest of the Drug Enforcement Administration, and the implementation of Prescription Drug Monitoring Programs (PDMP) began in the early 2000s (The PDMP Training and Technical Assistance Center).

I can personally relate to the opioid epidemic because my Husband battled with an addiction to opioids at the young age of eighteen, as well as the fact that I have been an Emergency Room Nurse for eight years and encounter individuals seeking opioid pain medications daily. After beginning to ingest for recreational purposes, my Husband’s addiction quickly grew. With the quick response of his family to get him treatment in a drug addiction program he was thankfully able to overcome the terrible habit and has now been sober for thirteen years. Unfortunately, success like his is a rarity in most cases. Many people may be introduced to narcotics as an illegal recreational use, while others may have a legitimate injury resulting in the need to an opioid prescription. Even with reasonable prescription administration individuals can quickly and easily become addicted to opioids. In all instances, once one has become dependent on these pain killers they will often times go to any lengths to get what they believe they need to survive regardless of the laws put in place. The PDMPs and other laws in place, may make it more difficult to obtain opioids and decrease unnecessary opioid prescriptions but they do not address the addictions that have either been willingly or unwillingly created. This is why I believe that there are other approaches that may be more effective to overcome the battle of the opioid epidemic.

Many supporters of this claim that PDMPs are not the most effective approach, have stated that these stricter mandates on opioid prescriptions have only caused the effect of addicts seeking relief of opioid needs by turning to heroin on the streets which is counter productive and even more dangerous. Yet some may disagree based on the grounds that some studies have show otherwise. A study published in the New England Journal of Medicine, stated that after the state of Florida implemented major prescription opioid policy changes there was only a slight increase in overdose deaths due to heroin (Compton, et al.). The conclusion of the study, which was entitled “Relationship between Nonmedical Prescription-Opioid use and Heroin use,” stated that they were unable to disprove a relationship between increased heroin overdose due to decreased availability of opioids, but that the “results consistently suggest that the transition to heroin use was occurring before most of these policies were enacted” (Compton, et al.). I would argue that this study does not fully convince me of the results because I have personal experience with my Emergency Department patients telling me that this is what they have had to do in order to survive their pain. Maybe individuals turning to heroin and increasing heroin overdoses are not occurring at such an alarming rate, but it is still a matter of contention taking place.

Yet some readers may challenge my views by insisting that these programs have helped to decrease overdose related deaths, misuse of prescription opioids, and over prescribing of opioids in states that use them. Wen discussed in the article “States with Prescription Drug Monitoring Mandates saw a Reduction in Opioids Prescribed to Medicaid Enrollees,” that states that mandated that prescribers register with their states monitoring program saw a 9-10 percent reduction in schedule II opioid prescriptions. (Wen, et al). Although I grant that these programs have had a positive effect on the opioid epidemic, I still maintain that we cannot ignore the result of addiction to opioids and leave this portion of the problem out in the wind.

Nevertheless, both supporters and critics of Prescription Drug Monitoring Programs will suggest otherwise and argue that PDMPs are effective with more robust mandates enforced by each state. The laws are regulated by each state and some research shows PDMPs are effective with improved structure and defined mandates. In order to increase compliance some states allow the office staff of providers to check the PDMP database, which increased compliance due to taking the burden off of prescribers since it can be time consuming. One study published in the Health Affairs journal focused on this topic and concluded that it resulted in reductions in opioid prescriptions with a high risk for misuse and overdose (Bao, Yuhua, et al). Bao also discussed that improvement of timeliness of available information on the databases, and allowing interstate sharing helped improve efficiency of PDMPs (Bao, Yuhua, et al). While these claims make sense and may be true there is still an argument that arises. While it is great that the excessive prescriptions seem to be decreasing, which will in turn hopefully decrease the result of people becoming addicted to opioids, the fact that these pain-killers are highly addictive cannot be ignored. Therefore, if people are prescribed them for a legitimate reason the risk of addiction is still there. It is for this reason, that I call for increased education to the opioid consumers by the front line healthcare providers to explain the seriousness of potential enslavement that these medications can cause.

If Prescription Drug Monitoring Programs have been so effective, why then was Dr Allareddy of the University of Iowa Stead Family Children’s Hospital, recently quoted by Jennifer Abbasi in her article “Emergency Department Opioid Misuse Diagnoses Increasing in Adolescents and Young Adults” where Dr Allareddy stated, “We were very surprised to find that several thousand kids coming to the ED for any cause were diagnosed to have opioid abuse or dependence” (Abbasi, Jennifer). Regardless of the efforts of PDMPs, this epidemic is still having an effect on our current young Americans. This tragedy needs to be more properly addressed to prevent the demise of the future of the American people.

The National Institute of Health (NIH) has acknowledged that there may be more effective initiatives to be taken by implementing the Helping to End Addiction Long-term (HEAL) program, which Congress supplemented five hundred million dollars in 2018 (Collins, Francis S., et al.). The HEAL plan calls upon support for advances in national priorities for addiction and pain research (Collins, Francis S., et al.). The HEAL initiative seeks two primary goals: “improving treatments for opioid misuse and addiction as well as enhancing strategies for pain management,” with the use of partnerships with other government agencies, academic institutions, patient advocates, and more. This proves that other organizations such as the NIH, agree that a problem still remains in our society today that needs to be addressed with a more collaborative approach involving all aspects of the opioid epidemic to be the most effective. This is why I believe we should all support the cause of bringing the fight against the opioid epidemic full circle with a synergistic approach involving addiction counseling, more thorough education with prescriptions, and alternative pain management options.

Works Cited

Abbasi, Jennifer. “Emergency Department Opioid Misuse Diagnoses Increasing in Adolescents and Young Adults.” Jama, vol. 318, no. 24, 2017, p. 2416.,doi:10.1001/jama.2017.16586.

Bao, Yuhua, et al. “Assessing The Impact Of State Policies For Prescription Drug Monitoring Programs On High-Risk Opioid Prescriptions.” Health Affairs, vol. 37, no. 10, Oct. 2018, pp. 1596–1604., doi:10.1377/hlthaff.2018.0512.

Collins, Francis S., et al. “Helping to End Addiction Over the Long-Term.” Jama, vol. 320, no. 2, 10 July 2018, p. 129., doi:10.1001/jama.2018.8826.

Compton, Wilson M., et al. “Relationship between Nonmedical Prescription-Opioid use and Heroin use.” The New England Journal of Medicine, vol. 374, no. 2, 2016, pp. 154- 163. ProQuest, https://login.ezproxy.uta.edu/login?url=https://search-proquest- com.ezproxy.uta.edu/docview/1757073992?accountid=7117, doi:http://dx.doi.org.ezproxy.uta.edu/10.1056/NEJMra1508490.

“History of Prescription Drug Monitoring Programs.” The Prescription Drug Monitoring Program Training and Technical Assistance Center, Brandeis University. Mar. 2018., www.pdmpassist.org/.

National Institute on Drug Abuse. “Opioid Overdose Crisis.” NIDA, 6 Mar. 2018, www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis.

Patrick, Stephen W., et al. “Implementation of Prescription Drug Monitoring Programs Associated with Reductions in Opioid-Related Death Rates.” Health Affairs, vol. 35, no. 7, 2016, pp. 1324-1332. ProQuest, https://login.ezproxy.uta.edu/login?url=https://search- proquest-com.ezproxy.uta.edu/docview/1809932085?accountid=7117, doi:http://dx.doi.org.ezproxy.uta.edu/10.1377/hlthaff.2015.1496.

Wen, Hefei, et al. “States With Prescription Drug Monitoring Mandates Saw A Reduction In Opioids Prescribed To Medicaid Enrollees.” Health Affairs, vol. 36, n