The stricter opioid prescription monitoring programs that President Donald Trump is pushing to combat the addiction epidemic may have the unintended effect of driving more people to heroin, a new study suggests.
Monitoring systems that require doctors to document and check the number, strength and frequency of opioid prescriptions that have been written for their patients were introduced in 2011.
President Trump has emphasized the importance of strengthening these measures to his plan of attack against the opioid epidemic.
It seems that doctors have been compliant, putting away their pens and prescribing less liberally.
However, a new assessment of the monitoring program’s effects on drug abuses and overdoses from Columbia University suggests that as prescriptions get harder to come by, more people may simply turn to more potent street drugs.
President Donald Trump’s plan for fighting the opioid epidemic leans heavily on prescription drug monitoring programs, but a new study shows they may drive people to illicit drugs
Prescriptions of opioids are widely credited for starting the opioid epidemic – but for many people battling addiction, the road ends at heroin or fentanyl.
Recent studies have shown that patients are prescribed some 60 percent more opioid painkillers after surgery than they use.
Often, the drugs make their way into the hands of friends, family or strangers willing to pay cash for the leftover pills.
An estimated 80 percent of people who are addicted to opioids started out taking prescription ones, such as the blockbuster drug OxyContin.
Since 1990, prescriptions of these drugs have soared, increasing 350 percent between 1990 and 2015.
President Trump, his opioid commission, and public health experts across the country have widely called for doctors to reign in their prescription rates.
Prescription drug monitoring programs (PDMP) have long been the go-to method for tracking who has prescribed what to patients, helping doctors to flag patients – and prescribers – who may be abusing the system by shopping for pills.
Amid the current opioid crisis, which killed more than 64,000 Americans in 2016, monitoring programs are now either in place or in the works in all 50 states and Washington, DC.
‘As such, it is crucial to determine if these programs are helping to reduce opioid overdoses,’ said study first author David Fink.
To that end, Fink – a doctoral candidate in epidemiology at the Mailman School of Public Health – and his team reviewed studies on the changes in fatal overdoses in areas as these programs have been implemented.
‘The evaluations would also help us determine whether specific administrative features of PDMPs correlate with these outcomes and, if so, which elements are most influential,’ Fink said.
He and his team of collaborators from Columbia and the University of California, Davis looked at 17 different articles on the programs and overdose rates.
Of those, 10 found links between the programs were linked to reductions in opioid overdoses – especially where physicians thoroughly and consistently reviewed patient prescribing histories.
Where the programs were effective, the databases were also updated at least weekly, had closely-guarded systems for authorization and also documented prescriptions of drugs that are not listed on the Drug Enforcement Administration’s list of scheduled controlled substances.
These were all promising signs and shed important light on the factors that make monitoring perform its intended function.
However, three of the previous articles revealed that monitoring could have the opposite of the desired effect.
In some places, after monitoring programs were introduced, heroin deaths increased.
‘This suggested to us that heroin substitution may have increased after PDMP-inspired restrictions on opioid prescribing,’ said senior study author Dr Silvia Martins of Columbia University.
‘We therefore caution that programs aimed at reducing prescription opioids should also address the supply and demand of illicit opioids.’