Prescription drug monitoring programs have shown considerable promise in tracking potential abusers.
These programs provide emergency departments and physicians with information about a patient's past use of controlled substances at the point of care. This can immediately flag any potential for abuse, making the doctor's decision to prescribe opioids – or not – much easier.
Now, the U.S. Substance Abuse and Mental Health Services Administration has funded at least nine states to combine their prescription monitoring programs with local hospital electronic health records and other systems already in place. These collaborations provide clinicians with a comprehensive history of controlled substance, so they can make informed decisions about patient health.
This has already had some success. For example, Illinois saw a 22 percent decrease in number of opioid prescriptions issued by prescribers and a 41 percent decrease in the number of patients who received at least one opioid prescription.
More information on the nature of the epidemic – particularly its link to rural areas – could yield clues about where and how to intervene. However, publicly available data have limited geographical information and don't cover all information we might need, such as data about dose or treatment duration. What data are available are restricted to protect the identity of individuals.
Rather than look at patients with opioid issues, we decided to look at the doctors who prescribe the drugs. Our group has been working with the state of South Carolina to combine our prescription drug monitoring program, called South Carolina Reporting and Identification Prescription Tracking System, or SCRIPTS, with Medicaid data.
While we were able to combine only two years' worth of data, our research led to important insights into the abuse potential within South Carolina.
By geocoding state prescription information, we found that a relatively small percentage of providers, concentrated in a few counties, accounted for most opioid prescriptions. In 2010, the top 10 percent of prescribers wrote more than half of all opioid prescriptions.
This group represents a potential target for physician education and engagement in handling pain management and appropriate use of opioids.