Prescription drug abuse has been a prominent public health problem in the US, with nearly 2 million Americans were dependent on prescription opioids in 2014. The Prescription Drug Monitoring Program (PDMP) is a promising intervention to improve opioid prescribing. This study examined the patterns in opioid prescribing before and after the PDMP policy periods. Drug prescription data were queried from the Automation of Reports & Consolidated Orders Systems (ARCOS) from 1997-2014. Thirty-two states were analyzed with the policy enacted year within the data range. Eighteen prescribed opioids were converted into morphine milligram equivalent (MME) and normalized by state population as MME per capita (MMEPC). The two-piece growth curve modeling tested the change in MMEPC rates before and after the PDMP policy. The rates of MMEPC indicated an upward trend from 1997-2010, and started to decline 2011-2014. In the two-piece model, the intercept of the pre-PDMP period indicated a MME level at 97.7mg per 1000 capita; at the year PDMP became enacted, MME level was at 705.5mg per 1000 capita. Comparison of the pre- and post-policy trends demonstrated that the rates of MMEPC significantly reduced after PDMP became operationalized (55.6mg per 1000 capita vs. 9.6mg per 1000 capita, p<0.001), although the rate at post-policy period continued to increase significantly (p=0.015). The rates of opioid prescriptions slowed down significantly after the PDMP policy became enacted. However, there is a temporal trend in decreasing opioid prescribing that coincides with PDMP implantation nationwide. More work is needed to determine if this relationship is causal.

Background: Nationwide, prescription monitoring program (PMP) data is emerging as the most-effective tool for monitoring the epidemic use of opioids. To illustrate this point, we used Mississippi PMP data to determine the statewide number and rate of prescriptions for opioid analgesics during 2014. We also evaluated trends in the prescription of opioids between 2011 and 2014. Methods: We analyzed Mississippi PMP data for 2011-2014. Implementing SQL statements, we performed descriptive statistical and trend analyses. We selected opioid agonist analgesics for this study. Data analyses included only Mississippi residents. Results: During 2014, there were 7,287,299 prescriptions for controlled substances, of which 3,348,009 (45.9%) were for opioid analgesics. On average, for every Mississippi resident in 2014, there were 2.4 prescriptions dispensed for controlled substances and 1.1 prescriptions for opioids. Hydrocodone was the leading prescribed opioid, accounting for 60.4% of all prescribed opioids, followed by tramadol (15.6%) and oxycodone (13.4%). Between 2011 and 2014, the overall trend in the prescription of opioid analgesics was positive. Compared to the baseline year of 2011, opioid analgesic prescriptions increased 3.2% by 2014. Trend comparisons on a yearly basis, however, revealed two distinct waves in opioid prescriptions practices over this time period. During the first two years of our time series, the opioid prescription rate in Mississippi jumped sharply, increasing 3.8 % between 2011 and 2012. After this initial increase, the number of opioid prescriptions in the state exhibited a slight downward trend, decreasing by an average annual rate of 0.3% in the last two years of our time series, 2013 and 2014. When analyzed individually, not all opioid analgesics followed the same positive trend. Compared to 2011 in 2014, the number of prescriptions for hydrocodone declined by 2.9 %, while the number of prescriptions for tramadol increased by 8.3% and the number of prescriptions for oxycodone, a strong opioid analgesic, climbed by 33.6%. Conclusion: Our study revealed alarmingly high rates of opioid prescriptions in Mississippi, findings underlining the need for statewide efforts to address such practices. We also identified a slight recent decrease in the total number of opioids prescribed. This positive trend may be counteracted, however, by a considerable increase in the prescription of stronger opioids such as oxycodone. The evaluation of statewide opioid usage should, therefore, follow a holistic approach incorporating metrics assessing the number of opioid prescriptions and pills as well as the strength and duration of opioid treatment.

This study was undertaken in response to evidence that many primary care practitioners struggle to comply with opioid prescribing guidelines for chronic non-cancer pain management. We used mixed methods, including key informant interviews, a survey of primary care practitioners, and quantitative analysis of prescription volume and provider registration in the state’s prescription drug monitoring program for 2013-2016. Key informants identified a preference for referring chronic pain patients to pain specialists, but geographic analysis showed limited access to these practitioners outside urban areas. Pain specialists focused on interventional procedures and rejected most chronic pain patients. Options for non-pharmaceutical pain management were very constrained, particularly for Medicaid beneficiaries. The number of primary care practitioners registered with the state’s prescription drug monitoring program have remained stable since participation became mandatory in 2012, but the volume of PCP opioid prescriptions declined. Survey respondents pointed to the preponderance of Medicaid coverage among their chronic pain patients and identified Medicaid reimbursement policy and managed care organizations’ position favoring referrals to pain specialists as deterrents to compliance with prescribing guidelines. Thus, barriers to compliance with opioid prescription guidelines are widespread. Chronic pain patients who are rejected by pain specialists are at risk for self-medication. Policies supporting primary care management of chronic pain with adequate non-pharmaceutical options would reduce the risk of self-medication and addiction. Policymakers and third-party payers should examine coverage policy carefully to assure that it supports, rather than impedes, practitioners’ ability to comply with best practices.

The recent price increases of prescription drugs in the United States have led the public to seek ways to assess the value of drugs and particularly high-priced drugs. Many innovative and accelerated approval drugs that are entering the market are being introduced at prices that put into question their access and affordability. Payers face challenges in managing healthcare budgets in the current pharmaceutical market while keeping value-based decision-making in mind. This has led to several private-sector initiatives to provide ways for evaluating the value of new prescription drugs and aid in the healthcare decision-making process. The audiences of these organizations include patients, physicians, payers and policymakers. The main organizations involved are the American Society of Clinical Oncology (ASCO), the American Heart Association (ACC–AHA), Memorial Sloan Kettering Cancer Center (MSKCC), the National Comprehensive Cancer Network (NCCN), and the Institute for Clinical and Economic Review (ICER). The frameworks presented by these organizations assess different elements associated with drug value, such as the extent of the treatment effect, quality of supporting clinical data, frequency of severe adverse events, and overall cost and impact of the drug on the health system budget. The objective of this presentation is to compare the frameworks and their appropriate use in value-based decision-making, to recognize their differences and similarities, and to identify their strengths and weaknesses in assessing value of prescription drugs.