CDC puts the spotlight on prescribing practices, studies drug monitoring programs

A report out of the Centers for Disease Control and Prevention (CDC) highlighted the urgency of certain drug prescribing practices and found that the oversight of these practices through state drug monitoring programs can be useful in learning more about variance in drug overdoses between the states. The CDC’s Morbidity and Mortality Weekly Report (MMWR) Surveillance Summary studied certain states’ prescription drug monitoring programs (PDMPs) and found that important clues to opioid abuse can be found in the data obtained through these programs.

Abuse and statistics

According to the CDC, drug overdose is the number one cause of injury death in the country. From 1999 to 2013, the death rate from drug overdose doubled. The CDC primarily attributes this significant increase to “misuse and abuse of prescription drugs, especially opioid analgesics, sedatives/tranquilizers, and stimulants.” CDC director Tom Frieden, M.D., M.P.H., highlighted that “every day, 44 people die in American communities from an overdose of prescription opioids and many more become addicted.”

Report methods and background

The CDC report was the first of its kind to look at the findings obtained through the administration of the CDC- and FDA-funded PDMPs in certain states. Specifically, the agency reviewed data from the eight states that submitted information from 2013—California, Delaware, Florida, Idaho, Louisiana, Maine, Ohio, and West Virginia.

Findings

In general the CDC’s review of the data resulted in a conclusion that the states’ prescribing practices vary wildly despite the fact that the same states exhibit similar trends in prevalence of the conditions that drugs being prescribed are used to treat. In turn, the CDC stated that “these findings point to the urgent need for improved prescribing practices, particularly for opioids, which in all eight states were prescribed twice as often as stimulants or benzodiazepines.” The CDC also uncovered these interesting trends in its review of the PDMPs: (1) that a majority of opioid prescriptions came from a small minority of prescribers; (2) the top 1 percent of prescribers in Delaware wrote one in four opioid prescriptions, while one in eight of the top 1 percent in Maine wrote such prescriptions; (3) despite the risk of adverse reactions while taking both kinds of substances together, those who received opioid prescriptions also received benzodiazepine prescriptions; and (4) the percentage of controlled substances paid for in cash varied almost threefold between the five states that had data on this measure. The CDC explained that payment for controlled substances in cash was often an indicator of abuse.

Next steps

To learn more about the trends in each state, the CDC urged states to use their PDMPs as “public health surveillance systems.” In turn, these identified prescribing behaviors can be used detect trends that indicate patterns of drug abuse and misuse. As evidence of this process at work, the CDC points to the use of New York’s PDMP to “demonstrate the impact of a multipronged intervention on opioid prescribing and opioid-related deaths in one of its boroughs.” The CDC also cited a study done by the Massachusetts Department of Public Health and its partners which showed how PDMPs can be used to track abuse behaviors and specifically how it has been done in that state in a ten year period. Using PDMPs in all states, the CDC argues, makes this possible on a grander scale. “The calculation of similar measures in multiple jurisdictions can now be conducted, and such comparisons can help identify norms and determine whether patterns or trends in one state are attributable to state policies or the result of larger, national influences.” This comparison between states with regard to prescribing behaviors is an important one to be made in the future, according to the CDC.