Governors tackle prescription drug abuse

According to the Centers for Disease Control and Prevention, 78 people die every day from opioid overdoses in the United States. The number of such deaths annually quadrupled between 1999 and 2014.

To address the situation, the National Governor’s Association Center for Best Practices developed a road map to help states prevent, respond and treat opioid misuse as well as strengthen law enforcement efforts to address illegal supply chain activity. “It is designed as a policy development tool, allowing a state to use all or portions of the road map as it applies to their unique situation,” NGA officials said.

Additionally, four states -- Delaware, Minnesota, New Mexico and Rhode Island -- will participate in a six-month long NGA learning lab on improving data-collection efforts and information sharing between law enforcement and public health officials as a way to combat opioid overdoses.

For the road map, NGA worked with 13 states between 2012 and 2015 to develop effective statewide programs to combat prescription opioid misuse.

The programs allow law enforcement to track where the painkillers are going and whether they are being overprescribed as well give health care providers more accurate, immediate information and the ability to examine trends and outcomes of state policies and programs. They also provide recommendations for prescription drug disposal programs and improved education, tighter requirements and prescribing guidelines for health care providers.

The road map consists of three main parts: assessment, policy development and implementation and evaluation.

1. Assessment. The assessment helps states develop a vision and goals as well as a comprehensive understanding of available tools to reduce opioid misuse and overdose. It should include a data review of the situation, key decision maker involvement and the creation of a task force.


2. Policy development. Policies should be established for health care and law enforcement for both prevention and response to opioid misuse. Health care strategies include development of guidelines for opioid prescribers, addressing opioid management in Medicaid and other state-run programs. Maximizing the use of public health and law enforcement data will help states monitor trends and strengthen prevention efforts. Public safety officials should share information across state agencies, leverage assets from partner entities to improve data collection and better target over-prescribers.


3. Implementation and evaluation. States should develop a working plan based on current priorities with clear, defined objectives. Once implemented, the plan should be continuously monitored and evaluated, then adjusted as necessary.

Role of prescription drug monitoring programs

A key part of any program is taking advantage of the states’ prescription drug monitoring program (PDMPs), statewide systems that house drug prescribing and dispensing data submitted by pharmacies and dispensing practitioners and that is used to monitor and analyze prescribing activity for research, enforcement and abuse prevention.

According to the NGA, PDMPs are being used by states as a tool for real-time information for health care providers and for examining trends and outcomes associated with state policies and programs.  To maximize the efficacy of their PDMPs, states should:

• Require drug providers to check the PDMP before prescribing Schedule II, III and IV controlled substances.
• Use PDMP data to provide proactive analyses and reporting to professional licensing boards and law enforcement.
• Make PDMPs easier to use by integrating PDMP data into electronic health records and health information systems.
• Ensure PDMP interoperability with other states.
• Use anonymized PDMP data to identify communities with elevated levels of high-risk opioid and benzodiazepine use.
• Ensure that drug courts can access PDMP data to monitor defendants who may try to obtain prescription controlled substances outside of treatment programs.

According to a recent report in Health Affairs, implementing a PDMP in 49 states reduced overdose deaths by an average of 1.12 per 100,000 people in the year after implementation. States with broader drug monitoring and frequent data updates had greater reductions in deaths compared to those with weaker programs.

“We estimate that if Missouri adopted a prescription drug monitoring program and other states enhanced their programs with robust features, there would be more than 600 fewer overdose deaths nationwide in 2016, preventing approximately two deaths each day,” the report authors wrote. As of July 2016, Missouri is the only state to not have a PDMP, due to privacy concerns.

While PDMPs can improve opioid misuse, their efficacy depends on how extensively they are used. Currently only 29 states require doctors to enter data into a PDMP database. Further, the latest version of the Comprehensive Addiction and Recovery Act eliminates the requirement for physicians to check PDMP databases to flag overusers of prescription drugs before writing a prescription, noted a Modern Healthcare article. While the legislation is aimed at encouraging users to seek treatment by decriminalizing drug addiction, it reduces states’ abilities to track opioid prescriptions.