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Prescription drug monitoring programs (PDMPs) are available in every state. Designed to collect and display prescriptions for controlled substances, they are becoming an indispensable part of prescribing practice for providers. The data they contain can help inform decisions about whether or not to prescribe controlled substances, including opioids for pain. However, the proportion of patients with opioid dependence who are captured by PDMPs remains unknown. Using data previously collected for an emergency department–based treatment trial in Connecticut, researchers determined the correlation between self-reported nonmedical prescription opioid use and opioid prescriptions recorded in the state's PDMP.
Of 329 patients with opioid dependence enrolled, only 118 (36%) had one or more opioid prescriptions recorded in the PDMP during the past year. Among the remaining 211 patients, 60 (28%) reported 15 or more days of nonmedical prescription opioid use during the prior 30 days, despite having no recorded opioid prescriptions.
Hawk K et al. Past-year prescription drug monitoring program opioid prescriptions and self-reported opioid use in an emergency department population with opioid use disorder. Acad Emerg Med 2017 Nov 22; [e-pub]. (http://dx.doi.org/10.1111/acem.13352)
Comment
Most states in the U.S., including mine, have mandated the use of PDMPs in certain cases. However, this paper's findings are a sobering reminder that most patients with opioid use disorder don't get their opioids from prescribers. Don't be falsely assured by a PDMP search that comes up blank — your history-taking abilities and gestalt are still very important when deciding whether to prescribe opioids.