Too many Arkansans are dying or being harmed by opioid drug misuse or overdose. Opioids were involved in 61% of all drug overdose deaths and about 40% of all emergency room visits for nonmedical drug use.
Deaths from prescription drug overdose are higher than deaths from illicit drugs. Arkansas continues to rank second in the nation in the number of opioid prescriptions per 100 people.
Citizens are demanding action, and policymakers are working to find solutions to stem the tide of addiction misery. Every societal ill seems to surround this epidemic: broken families, child abuse and neglect, lost jobs, domestic abuse, arrest and imprisonment.
While solutions to this epidemic are complex, Arkansas has a valuable resource to help reduce the heartbreaks associated with opioids and other controlled substance misuse.
Created by our General Assembly in 2011, the Arkansas Prescription Drug Monitoring Program (AR-PDMP) is a state-controlled database where medical professionals can identify and reduce prescription drug abuse.
Prescribers are required to check the PDMP before prescribing Class II or III controlled substance opioids or prescribing a benzodiazepine for the first time. All licensed pharmacies and licensed dispensers are required to report dispensing data to the AR-PDMP for every controlled substance, including opioids. The benefits of AR-PDMP include the ability to:
• Determine when drug abuse or diversion occurs;
• Track prescriptions for controlled substances;
• Identify overprescribing problems;
• Collect data on controlled substance prescriptions;
• Have access to data 24/7 and access to interstate data;
• Help providers work together to improve patient care by the legitimate use of controlled substances;
• Receive an automatic calculation of the morphine-equivalent dose (MED) for each opioid, based on the number of prescriptions dispensed to a patient during the date range requested (narcotic pain reliever doses greater than 50 MED increase the risk of overdose and death);
• Locate current substance abuse resources including prescribing guidelines, continuing education for opioid prescribing, and local and national addiction programs; and
• Have higher confidence in prescribing opioids safely, as was reported by most physicians using AR-PDMP.
The database helps physicians identify patients seeking prescriptions from multiple providers (“doctor shopping”), a behavior that greatly increases the risk of overdose death. AR-PDMP access is granted to physicians, pharmacists, authorized prescribers, law enforcement, regulatory boards and the state medical examiner. Legislative amendments have allowed these professionals to delegate PDMP access to staff members whom they supervise. All users must be approved for access according to statutory requirements. Access is through a secure website requiring authorized users to use their password.
AR-PDMP includes a clinical alert feature that informs prescribers of questionable patient activity concerning controlled substances. It also alerts prescribers if a patient is receiving prescriptions for an opioid and benzodiazepine concurrently. To expand access to treatment for opioid abusers, the number of patients to whom a physician can prescribe the maintenance drug buprenorphine has been increased. Unlike methadone for medication-addiction treatment, buprenorphine can be prescribed from conventional medical practices and dispensed from retail pharmacies. The ability to prescribe it has been expanded to include physician assistants, nurse practitioners and other practitioners.
PDMPs save lives. A Health Affairs article credits PDMPs nationwide with a sustained reduction in opioid prescriptions. Another article credits PDMPs with the nationwide reduction in opioid deaths. In Arkansas, the incidence of doctor shopping has decreased 74% since AR-PDMP implementation. The number of opioid prescriptions and individuals receiving daily narcotic pain relievers greater than 100 MED has steadily decreased, reflecting a positive change in opioid prescribing in Arkansas.
While the AR-PDMP is making a difference, the damage and death from opioids is still too high. Arkansas policy makers must do more to improve the state’s standing. I hope that lawmakers will come to the 2019 legislative session with many ideas to help solve this statewide epidemic.
Editor’s note: Ray Hanley is president and CEO of AFMC, a company that works healthcare providers and patients to improve quality of care and outcomes. The opinions expressed are those of the author.