Who uses a prescription drug monitoring program and how? Insights from a statewide survey of Oregon clinicians.
Prescription drug monitoring programs (PDMPs) are relatively new but potentially useful tools to enhance prudent prescribing of controlled substances. However, little is known about the types of clinicians who make the most use of PDMPs, how these programs are incorporated into clinicians' work flow, or how clinicians and patients respond to the information. We therefore surveyed a random sample of Oregon providers, with 1,065 respondents. Clinicians in emergency medicine, primary care, and pain and addiction specialties were the largest number of registrants, but many frequent prescribers of controlled substances were not registered to use the PDMP. Among users, 95% reported accessing the PDMP when they suspected a patient of abuse or diversion, but fewer than half would check it for every new patient or every time they prescribe a controlled drug. Nearly all PDMP users reported that they discuss worrisome PDMP data with patients; 54% reported making mental health or substance abuse referrals, and 36% reported sometimes discharging patients from the practice. Clinicians reported frequent patient denial or anger and only occasional requests for help with drug dependence. More research is needed to optimize how clinicians use PDMPs across settings and how clinicians and patients respond to the data.


CONCLUSIONS
This study examined differences between PDMP users and nonusers and how clinicians in various specialties use PDMPs in practice. A better understanding of effective PDMP use will facilitate access to treatment for patients with pain while curbing the prescription drug epidemic and may ultimately reduce abuse, misuse, and overdose death.
Acumentra Health, Portland, Oregon. Electronic address: jirvine@acumentra.org.
Jessica M
JM
Irvine
Acumentra Health, Portland, Oregon.
Sara E
SE
Hallvik
Acumentra Health, Portland, Oregon.
Christi
C
Hildebran
Department of Family Medicine, Oregon Health and Science University, Portland, Oregon; Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland, Oregon; Division of Biostatistics, Oregon Health and Science University, Portland, Oregon.
Miguel
M
Marino
Public Health Division of the Oregon Health Authority, Portland, Oregon.
Todd
T
Beran
Department of Family Medicine, Oregon Health and Science University, Portland, Oregon; Department of Medicine, Oregon Health and Science University, Portland, Oregon; Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland, Oregon; Center for Research in Occupational and Environmental Toxicology, Oregon Health and Science University, Portland, Oregon.
Richard A
RA
Deyo
D000328:Adult; D000367:Age Factors; D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D016208:Databases, Factual / Q000706:statistics & numerical data; D016903:Drug Monitoring; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009922:Oregon; D010146:Pain / Q000188:drug therapy*; D010818:Practice Patterns, Physicians'; D063487:Prescription Drug Misuse; D055553:Prescription Drugs; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000517:prevention & control; D055815:Young Adult
D000701:Analgesics, Opioid; D055553:Prescription Drugs
Prescription drug monitoring program; controlled substances; opioid prescribing; prescription drug abuse; survey