PDMP's have no effect on opioid OD death rates

[drusso]

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http://papers.nber.org/tmp/38692-w23148.pdf

Classic example of confusing surrogate endpoints for real endpoints: Mandatory access of PDMP's may reduce surrogate endpoints of misuse or doctor-shopping, but have no effect on reducing overdose deaths.

 

[Ducttape]

actually... the article on page 16-17 states that the trends are negative (ie decrease in opioid poisonings) with “must have” PMDPs but do not reach clinical significance to reject the null hypothesis, and may be due to other factors, such as these Medicare beneficiaries( the population studies) turn to out of state sources of opioids.

They postulate also the possibility of increased use of illicit substances for the not statistically significant reduction in poisonings.

 

[Aether2000]

The results are not terribly surprising since mandatory pdmp checks without any obligatory action to be taken based on the results from the pdmp, would have no effect on drug overdoses. For instance, if a doctor notes on the pdmp a patient is receiving benzodiazepines from other doctors but takes no action in further reductions in opioid dosage, then the mandatory pdmp checks are useless. Also alcohol use is rampant in the chronic pain population and checks of a pdmp will not help reduce drug overdose due to combined effects. Urine drug screens are far more valuable for actual risk assessment compared to that of the pdmp.

 

[drusso]

The results are not terribly surprising since mandatory pdmp checks without any obligatory action to be taken based on the results from the pdmp, would have no effect on drug overdoses. For instance, if a doctor notes on the pdmp a patient is receiving benzodiazepines from other doctors but takes no action in further reductions in opioid dosage, then the mandatory pdmp checks are useless. Also alcohol use is rampant in the chronic pain population and checks of a pdmp will not help reduce drug overdose due to combined effects. Urine drug screens are far more valuable for actual risk assessment compared to that of the pdmp.

Can you think of other opioid-related health policies that lack evidence to support their implementation?

 

[Ducttape]

Drcomm could probably give you an exhausting list....


FWIW are PDMPs for stopping opioid deaths or for diversion?



To the best of my understanding, for example, the NY state version is called the I-STOP, which is short for “Internet System for Tracking Overprescribing”....

 

[catalyzt]

FWIW are PDMPs for stopping opioid deaths or for diversion?



To the best of my understanding, for example, the NY state version is called the I-STOP, which is short for “Internet System for Tracking Overprescribing”....

I'm a retail pharmacist with one of the big 3 chains. I have been using my state's PDMP since I started practicing pharmacy ten years ago. I use the PDMP for the primary purpose of tracking drug diversion (i.e. doctor shopping, pharmacy shopping). I want to be able to catch the patients that are going to multiple urgent care offices as well as the ER for pain prescriptions and then dropping them off at multiple pharmacies in a hope that they don't get caught. I see diversion quite often and the use of this tool has been invaluable for me and my pharmacist friends.

 

[hyperalgesia]

This paper looks only at Medicare recipient opioid poisoning. Like it's been said, most of these meds are probably diverted so I wouldn't expect an impact on "patients".