An Experimental Test of the Effectiveness of Unsolicited Reporting by a Prescription Drug Monitoring Program in Reducing Inappropriate Acquisition of Opioids

OBJECTIVES: This research looked at whether notifying prescribers and pharmacies about patients who use multiple providers to obtain opioids reduces their prescribing activity (including use of multiple providers, numbers of opioid prescriptions, or amounts of opioids obtained). DESIGN: Nevada's prescription drug monitoring program (PDMP) identified patients using multiple providers to obtain opioids and assigned them alternately to an intervention or control group. Controlled substance prescription histories were sent only to intervention patients' providers. Subsequent opioid purchases by patients in both groups were compared. SETTING: All pharmacies and dispensers in the state are required to report every prescription for Schedule II-IV opioids dispensed to the PDMP. SUBJECTS: All patients receiving opioids from more than four different Nevada prescribers and more than four pharmacies during the previous six months assigned to the intervention (N = 436) or control group (N = 441). METHODS: We used ordinary least squares regression to estimate notification effects on each outcome, accounting for preexisting differences among groups. RESULTS: Providers receiving unsolicited notices were 13% less likely to continue prescribing to patients than providers not notified. Eighty-four percent of the intervention patients' prescribers discontinued prescribing to them after assignment, compared with 80.5% of the control group's prescribers-who were not notified. Because patients in both groups found other prescribers to replace discontinued prescribers, notification had at most a small effect on patients' use of multiple providers, numbers of opioid prescriptions, or amounts of opioids purchased. CONCLUSIONS: Requiring prescribers to solicit patients' prescription histories is likely to be a more effective use of PDMP resources than proactive notification.