Prescription drug monitoring programs (PDMPs) may prevent patients with cancer who have legitimate pain management needs from receiving opioids, according to a research letter published in JAMA Oncology.
In the past several years, more than 30 states in the United States have created PDMPs to reduce the rate of opioid prescription fills. While this has helped stymie the opioid crisis, the widespread effects of these programs on patients with cancer have not previously been described. For this study, researchers explored links between mandatory PDMP use and changes in rates of oncologist-requested opioid prescription fills for Medicare patients.
The investigators used Medicare Part D Prescriber files recorded between 2013 and 2017, requesting data only for clinicians practicing in hematology or oncology. For each state and year considered, the authors classified states by whether PDMPs were mandatory, and, if so, whether exemptions were made for patients with cancer.
By 2017, 21 states had enacted leglistation making PDMP use mandatory, with 5 of those states exempting PDMP use in the cancer setting. Data were available for 40,739 patients overall, with 32,104 patients treated in states without mandatory PDMP access requirements. There were 6720 patients treated in states with access requirements and no exemption for patients with cancer and 1915 patients treated in states with access requirements and an exemption for patients with cancer.
Compared with states without PDMP access requirements, fewer patients treated in states with requirements without a cancer exemption (2.8% decline) and in states with requirements with a cancer exemption (4.8% decline) had opioid prescriptions filled by an oncologist.
“These results show that with or without an exemption for patients with cancer, the percent of patients treated by a medical or hematologic oncologist receiving opioids declined after mandatory-access PDMPs were implemented,” the authors wrote. “As more states contemplate policies to alleviate the opioid crisis, it is critical to understand how they affect both problematic and legitimate opioid use.”
Graetz I, Yarbrough CR, Hu X, Howard DH. Association of mandatory-access prescription drug monitoring programs with opioid prescriptions among Medicare patients treated by a medical or hematologic oncologist [published online May 7, 2020]. JAMA Oncol. doi: 10.1001/jamaoncol.2020.0804