Development and Design of the Prescription Behavior Surveillance System (PBSS): Preliminary Results

Overdose deaths from prescription drugs are now considered an epidemic by the Centers for Disease Control and Prevention.  In an effort to address prescription drug abuse and its consequences, 49 states have developed prescription drug monitoring programs (PDMPs), which collect, monitor, and disseminate data on dispensed controlled substances. Unlike most health outcome data, which may take one to two years to become available, PDMP data are available on a timelier basis, making PDMP data ideal for public health surveillance purposes. This paper reports on the design and development of the Prescription Behavior Surveillance System (PBSS), a new longitudinal, multi-state database of de-identified PDMP data created as an early warning surveillance tool to help identify emerging trends in controlled substance prescribing, use, abuse, and diversion.  The paper describes PBSS objectives, its governance structure, state PDMP recruitment and participation, data security procedures, and the development of a set of prescription behavior measures for routine surveillance reports.  PBSS measures include indicators of risky patient-, prescriber- and dispenser-level behavior over time and by demographic and controlled substance drug categories. States joining PBSS submit two to three years of baseline data followed by quarterly updates going forward. We report preliminary results from 6 states, including prescribing rates of major drug classes and selected drugs, average daily dosages for opioids in morphine milligram equivalents (MMEs), multiple provider episode rates, and risk indicators for prescribers and dispensers. Finally, we discuss other planned and potential uses of the PBSS for epidemiologic analysis and evaluation.