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Promoting Prescription Drug Monitoring Programs for Population Health: Research and Policy Implications

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Abstract

This overview of prescription drug abuse includes historical background, key concepts, and discussion of the prevalence of drug abuse, treatments, and policy issues implicated in ending the epidemic. Prescription opioid medication abuse has been declared a national crisis by experts in medicine, substance use, public health, and pain management, culminating in a declaration made by the President of the United States that opioid misuse and abuse is a national health emergency. In this comprehensive text, expert scholars analyze and address a wide range of issues in, obstacles to, and potential solutions for this emergency, which caused more than 50,000 deaths in 2016 alone. It covers a variety of topics related to prescription misuse from both clinical and academic perspectives. After an opening containing background material on the most commonly misused medications, chapters examine subgroups engaged in misuse and special medical environments where misuse issues are key. They then cover U.S. policy, perspectives outside the U.S., and theories that may explain the misuse phenomena. This book will serve as a resource for students and professionals in fields related to prescription drug abuse–including psychology, sociology, medicine, and public policy–and is accessible to individuals not trained in these fields.
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Article
Objective The aim of this study is to investigate how healthcare practitioners use real-time prescription monitoring tools in clinical practice.Methods An online survey was distributed to Australian prescribers and pharmacists who use a real-time prescription monitoring tool. Data were analysed and descriptive statistics summarised participant characteristics and responses. A Chi-squared test was conducted to test the difference between prescribers and pharmacists.ResultsThe majority of participants agreed that real-time prescription monitoring (RTPM) information is useful (92.2%) and the tool is valuable for informing clinical decisions (90.2%); however, just over half reported that they had changed their prescribing or dispensing practices as a result of RTPM information (51.0%), and they employed evidence-based clinical interventions to varying degrees. No statistically significant differences were detected between pharmacists and prescribers and perceptions on tool use.Conclusions This is the first known study to investigate practitioner use of RTPM tools in Australia, and is a starting point for further research. What constitutes 'success' in the clinical application of RTPM tools is yet to be realised.
Article
Full-text available
Background and aims Prescription drug monitoring programs (PDMP), defined as state‐level databases used in the USA that collect prescribing information when controlled substances are dispensed, have varied substantially between states and over time. Little is known about the combinations of PDMP features that, collectively, may produce the greatest impact on prescribing and overdose. We aimed to (1) identify the types of PDMP models that have developed from 1999 to 2016, (2) estimate whether states have transitioned across PDMP models over time, and (3) examine whether states have adopted different types of PDMP models in response to the burden of opioid overdose. Methods A latent transition analysis of PDMP models based on an adaptation of nine PDMP characteristics classified by prescription opioid policy experts as potentially important determinants of prescribing practices and prescription opioid overdose events. Results We divided the time period into three intervals (1999‐2004, 2005‐2009, 2010‐2016), and found three distinct PDMP classes in each interval. The classes in the first and second interval can be characterized as “No/Weak”, “Proactive”, and “Reactive” types of PDMPs, and in the third interval as “Weak”, “Cooperative”, and “Proactive”. The meaning of these classes changed over time: until 2009, states in the “No/Weak” class had no active PDMP, whereas states in the “Proactive” class were more likely to proactively provide unsolicited information to PDMP users, provide open access to law enforcement, and require more frequent data reporting than states in the “Reactive” class. In 2010‐2016, the “Weak” class resembled the “Reactive” class in previous intervals. States in the “Cooperative” class in 2010‐2016 were less likely than states in the “Proactive” class proactively to provide unsolicited reports, or to provide open access to law enforcement; however, they were more likely than those in the “Proactive” class to share PDMP data with other states, and to report more federal drug schedules. Conclusions Since 1999, US states have tended to transition to more robust classes of prescription drug monitoring programs (PDMPs). Opioid overdose deaths in prior years predicted the state's PDMP class but did not predict transitions between PDMP classes over time.
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