Miller Chaim, Ilyas Asif M
Rothman Opioid Foundation, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, USA.
Orthopaedic Surgery, Sidney Kimmel Medical College, Philadelphia, USA.
Cureus. 2022 Aug 11;14(8):e27879. doi: 10.7759/cureus.27879. eCollection 2022 Aug.
The opioid epidemic is a major public health crisis in the United States. Legislators have enacted various strategies to combat this crisis, including the implementation of statewide prescription drug monitoring programs (PDMP). These PDMPs are electronic databases that collect and analyze patient prescription data on controlled substances, allowing physicians to review prior prescriptions before prescribing. The objective of this study was to determine opioid prescribing patterns after the implementation of a statewide PDMP in Pennsylvania.
After IRB approval, PDMP data were obtained from the Pennsylvania Department of Health. Data obtained included: drug name, days supplied, refill count, and partially filled prescriptions. The study timeline was three years, from first quarter 2017 through first quarter 2020.
Over the three years post-implementation of a PDMP, Pennsylvania saw a 33% decrease in the overall quantity of opioid pills prescribed (677,194 absolute reduction), a 9% decrease in partially filled prescriptions (5,821 absolute reduction), and an 18% decrease in authorized refills (525 absolute reduction). Opioid prescriptions for greater than seven days of supply decreased by a larger amount than prescriptions for less than seven days of supply (43% vs 27%). Similarly, prescriptions for more than 22 pills saw a greater decrease than prescriptions for less than 21 days (37% vs 21%). However, the rate of decrease in opioid pills prescribed lessened from 14% in the first two years post implementation, to 10% in the third year. The decrease in partially filled opioid prescriptions for the first two years averaged 14% per year, while it increased by 23% in the third year. An 8% average decrease occurred in the rate of refills for opioid prescriptions for the first two years post implementation, followed by a 3% reduction in the third year.
There was a 33% decrease in the overall quantity of opioid pills prescribed in the three years after the implementation of the PDMP. The first two years after implementation saw the largest decreases in prescribing habits, which slowed in the third year. More data are needed to show the long-term effects of implementing a statewide PDMP.
阿片类药物泛滥是美国的一个重大公共卫生危机。立法者已制定各种策略来应对这一危机，包括实施全州范围的处方药监测计划（PDMP）。这些PDMP是电子数据库，收集和分析有关管制物质的患者处方数据，使医生在开处方前能够查看既往处方。本研究的目的是确定宾夕法尼亚州实施全州范围的PDMP后阿片类药物的处方模式。
经机构审查委员会（IRB）批准后，从宾夕法尼亚州卫生部获取PDMP数据。获取的数据包括：药品名称、供应天数、续方次数和部分配药的处方。研究时间跨度为三年，从2017年第一季度至2020年第一季度。
在实施PDMP后的三年里，宾夕法尼亚州阿片类药丸的处方总量下降了33%（绝对减少677,194剂），部分配药的处方减少了9%（绝对减少5,821份），授权续方减少了18%（绝对减少525次）。供应天数超过七天的阿片类药物处方的减少幅度大于供应天数少于七天的处方（43%对27%）。同样，超过22片的处方的减少幅度大于少于21片的处方（37%对21%）。然而，实施后前两年阿片类药丸处方的减少率从14%降至第三年的10%。前两年部分配药的阿片类药物处方平均每年减少14%，而第三年则增加了23%。实施后前两年阿片类药物处方的续方率平均下降了8%，随后第三年下降了3%。
实施PDMP后的三年里，阿片类药丸的处方总量下降了33%。实施后的前两年处方习惯下降幅度最大，第三年有所放缓。需要更多数据来显示实施全州范围的PDMP的长期影响。
