Prescription drug monitoring program (PDMP) utilization and outcomes within the West Palm Beach Veterans Affairs (VA) healthcare system

Authors

DOI:

https://doi.org/10.5055/jom.2023.0768

Keywords:

prescription drug monitoring programs, controlled substances, Florida, Veterans

Abstract

Objective: Prescription drug monitoring programs (PDMPs) can identify patients at risk of controlled substance (CS) polypharmacy and accidental poisoning.

Design: A retrospective pre-/post-intervention review of a random sample of provider notes with documentation of PDMP outcomes was completed before and after the enactment of a Florida law mandating PDMP queries.

Setting: West Palm Beach Veterans Affairs Health Care System, which provides inpatient and outpatient services.

Participants: Reviewed a random sample of 10 percent of progress notes documenting PDMP outcomes between September and November 2017 and the same timeframe of 2018.

Interventions: Florida enacted a law in March 2018 requiring PDMP queries to be completed for all new and renewed CS prescriptions.

Main outcome measured: The primary outcome was to compare PDMP utilization and prescribing decisions based on query results before and after the enactment of the law.

Results: The number of progress notes documenting PDMP queries increased by over 350 percent from 2017 to 2018. In 2017 and 2018, 30.6 percent (68/222) and 20.8 percent (164/790) of PDMP queries found non-Veterans Affairs (VA) CS prescriptions, respectively. Providers decided to avoid prescribing CS prescriptions in 23.5 percent (16/68) of patients with non-VA CS prescriptions found in 2017 and 11 percent (18/164) in 2018. Overlapping or unsafe combinations were identified in 10 percent (7/68) of queries with non-VA prescriptions found in 2017 and 14 percent (23/164) in 2018.

Conclusions: Mandating PDMP queries resulted in an increase in the total number of queries, positive findings, and overlapping CS prescriptions. Outcomes of PDMP mandate impacted prescribing by discontinuation and avoidance of CS initiation in 10-15 percent of patients.

Author Biographies

Lauren Schroth, PharmD, BCPS

Clinical Pharmacist Pracitioner, Washington DC VA Medical Center, Washington, DC

Sandra DiScala, PharmD, BCPS

Clinical Pharmacist Pracitioner, West Palm Beach Veterans Affairs Health Care System, West Palm Beach, Florida

Christine M. Vartan, PharmD, BCPS

Clinical Pharmacist Pracitioner, West Palm Beach Veterans Affairs Health Care System, West Palm Beach, Florida

Hiroko Forbes, PharmD

Associate Chief of Pharmacy, West Palm Beach Veterans Affairs Health Care System, West Palm Beach, Florida

References

Hedegaard H, Miniño AM, Warner M: Drug Overdose Deaths in the United States, 1999–2017. NCHS Data Brief No. 329. Hyattsville, MD: National Center for Health Statistics, 2018.

Jones CM, Mack KA, Paulozzi LJ: Pharmaceutical overdose deaths, United States, 2010. JAMA. 2013; 309(7): 657-659.

Centers for Disease Control and Prevention: Wide-Ranging Online Data for Epidemiologic Research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics, 2019. Available at http://wonder.cdc.gov. Accessed March 15, 2021.

Kominek C: Current and emerging options to combat the opioid epidemic. Am J Manag Care. 2018; 24(10 Suppl.): S207-S214.

The Opioid Therapy for Chronic Pain Work Group: VA/DoD clinical practice guideline for opioid therapy for chronic pain. Version 3.0-2017. US Department of Veterans Affairs Web Site. 2017. Available at www.healthquality.va.gov/guidelines/Pain/cot/VADoDOTCPG022717.pdf. Accessed March 15, 2021.

Simon K, Worthy SL, Barnes MC, et al.: Abuse-deterrent formulations: Transitioning the pharmaceutical market to improve public health and safety. Ther Adv Drug Saf. 2015; 6(2): 67-79.

Oliva EM, Christopher MLD, Wells D, et al.: Opioid overdose education and naloxone distribution: Development of the Veterans Health Administration's national program. J Am Pharm Assoc (2003). 2017; 57(2S): S168-S179.

Argoff CE, Alford DP, Fudin J, et al.: Rational urine drug monitoring in patient receiving opioids for chronic pain: Consensus recommendations. Pain Med. 2018; 19(1): 97-117.

Prescription Drug Monitoring Frequently Asked Questions (FAQ): Prescription drug monitoring program training and technical assistance center. 2019. Available at https://www.pdmpassist.org/content/prescription-drug-monitoring-frequently-askedquestions-faq. Accessed March 15, 2021.

Office of National Drug Control Policy; US Executive Office of the President: Epidemic: Responding to America's Prescription Drug Abuse Crisis. Washington, DC: Office of National Drug Control Policy, 2011.

Florida Department of Health: 2016-2017 Prescription drug monitoring program annual report. 2017. Available at http://www.floridahealth.gov/statistics-and-data/e-forcse/funding/2017pdmpannualreport.pdf. Accessed March 15, 2021.

Department of Veterans Affairs: Querying state prescription drug monitoring programs (PDMP). 2016. Available at https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3283. VHA Directive 1306. Accessed March 15, 2021.

Scholl L, Seth P, Kariisa M, et al.: Drug and opioid-involved overdose deaths—United States, 2013–2017. MMWR Morb Mortal Wkly Rep. 2019; 67(5152): 1419-1427.

Controlled Substances: Fla. § 456.0301. 2018. Available at http://laws.flrules.org/2018/13. Accessed March 15, 2021.

Scott J: Florida's new law on controlled substance prescribing. Florida Medical Association. Available at https://flmedical.org/Florida/Florida_Public/Docs/FMA-Opioid-HB21.pdf. Accessed March 15, 2021.

US Department of Veterans Affairs: Eligibility for Veterans pension. Available at https://www.va.gov/pension/eligibility/. Accessed March 15, 2021.

US Department of Veterans Affairs: About VA disability ratings. Available at https://www.va.gov/disability/about-disabilityratings/. Accessed March 15, 2021.

National Center for Injury Prevention and Control: CDC Compilation of Benzodiazepines, Muscle Relaxants, Stimulants, Zolpidem, and Opioid Analgesics with Oral Morphine Milligram Equivalent Conversion Factors. Atlanta, GA: Centers for Disease Control and Prevention, 2017. Available at https://www.cdc.gov/drugoverdose/resources/data.html. Accessed March 15, 2021.

Prickett T, Rothman D, Crawford EF, et al.: Mental health among military personnel and veterans. N C Med J. 2015; 76(5): 299-306.

Kessler RC, Chiu WT, Demler O, et al.: Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the national comorbidity survey replication. Arch Gen Psychiatry. 2005; 62(6): 617-627.

Knutson KP, Stellato JM, Volger KR, et al.: Does COPD differ by veteran status in males 50-79 years of age? Dis Disord. 2018; 2(1): 1-5. DOI: 10.15761/JDD.1000109.

Troxel WM, Shih RA, Pedersen ER, et al.: Sleep in the military: Promoting healthy sleep among US servicemembers. Rand Health Q. 2015; 5(2): 19.

Defense and Veterans Brain Injury Center: DoD worldwide numbers for TBI. Available at https://dvbic.dcoe.mil/dod-worldwide-numbers-tbi. Accessed March 15, 2021.

Regier DA, Farmer ME, Rae DS, et al.: Comorbidity of mental disorders with alcohol and other drug abuse: Results from the epidemiologic catchment area (ECA) study. JAMA. 1990; 264(19): 2511-2518.

Sacks AL, Fenske CL, Gordon WA, et al.: Co-morbidity of substance abuse and traumatic brain injury. J Dual Diagn. 2009; 5(3): 404-417.

Harrison-Felix C, Pretz C, Hammond FM, et al.: Life expectancy after inpatient rehabilitation for traumatic brain injury in the United States. J Neurotrauma. 2015; 32(23): 1893-1901.

Vozoris NT, Wang X, Fischer HD: Incident opioid drug use and adverse respiratory outcomes among older adults with COPD. Eur Respir J. 2016; 48(3): 683-693.

Webster LR: Risk factors for opioid-use disorder and overdose. Anesth Analg. 2017; 125(5): 1741-1748.

Turner BJ, Liang Y: Drug overdose in a retrospective cohort with non-cancer pain treated with opioids, antidepressants, and/or sedative-hypnotics: Interactions with mental health disorders. J Gen Intern Med. 2015; 30(8): 1081-1096.

Sun EC, Dixit A, Humphreys K, et al.: Association between concurrent use of prescription opioids and benzodiazepines and overdose: Retrospective analysis. BMJ. 2017; 356: j760.

Yang Z, Wisley B, Bohm M, et al.: Defining risk of prescription opioid overdose: Pharmacy shopping and overlapping prescriptions among long-term opioid users in Medicaid. J Pain. 2015; 16(5): 455-453.

Florida Department of Health: 2017-2018 prescription drug monitoring program annual report. 2018. Available at http://www.floridahealth.gov/statistics-and-data/e-forcse/health_care_practitioners/_documents/2018-pdmp-annual-report.pdf. Accessed March 15, 2021.

Florida Department of Health: 2018-2019 prescription drug monitoring program annual report. 2019. Available at http://www.floridahealth.gov/statistics-and-data/e-forcse/lawsrules/2019-pdmp-annual-report.pdf. Accessed March 15, 2021.

Garg RK, Fulton-Kehoe D, Franklin GM: Patterns of opioid use and risk of opioid overdose death among Medicaid patients. Med Care. 2017; 55(7): 661-668.

Dowell D, Zhang K, Noonan RK, et al.: Mandatory provider review and pain clinic laws reduce the amounts of opioid prescribed and overdose death rates. Health Aff (Millwood). 2016; 35(10): 1876-1883.

Strickler GK, Zhang K, Halpin JF, et al.: Effects of mandatory prescription drug monitoring program (PDMP) use laws on prescriber registration and use and on risky prescribing. Drug Alcohol Depend. 2019; 199: 1-9.

Bachhuber MA, Tuazon E, Nolan ML, et al.: Impact of prescription drug monitoring program use mandate on potentially problematic patterns of opioid analgesic prescriptions in New York City. Pharmacoepidemiol Drug Saf. 2019; 28(5): 734-739.

Published

03/01/2023

How to Cite

Schroth, PharmD, BCPS, L., S. DiScala, PharmD, BCPS, C. M. Vartan, PharmD, BCPS, and H. Forbes, PharmD. “Prescription Drug Monitoring Program (PDMP) Utilization and Outcomes Within the West Palm Beach Veterans Affairs (VA) Healthcare System”. Journal of Opioid Management, vol. 19, no. 2, Mar. 2023, pp. 139-47, doi:10.5055/jom.2023.0768.