Does opioid prescription monitoring lead patients to seek more dangerous alternatives?

In June, Missouri became the 50th state to establish a statewide prescription drug monitoring program. However, experts are still split over whether such programs effectively decrease opioid-related overdoses, Kaiser Health News reported July 26.

Kentucky was the first state to require prescribers and dispensers to use a monitoring system. Shortly after the state began using the system in 2012, the number of opioid prescriptions and overdoses from prescription opioids decreased slightly. However, overall opioid overdose deaths have been steadily increasing since 2012, with the exception of slight decreases in 2018 and 2019, according to CDC data.

Some public health experts say prescription monitoring programs force patients who have an addiction to turn to more dangerous alternatives, such as heroin and fentanyl. Others say the absence of such programs makes it easier for patients to visit different physicians to obtain prescriptions for the same drug and for providers to overprescribe.

Stephen Wood, a nurse practitioner who is also a visiting substance abuse bioethics researcher at Cambridge, Mass.-based Harvard University, told Kaiser Health News prescription monitoring programs can often make patients feel like they're in trouble without offering any viable treatment options. At Boston-based Carney Hospital, he and his colleagues rely more on toxicology screens, signs such as injection marks on skin.

"Rather than pulling out a piece of paper and being accusatory, I find it’s much better to present myself as a caring provider and sit down and have an honest discussion," Mr. Wood said.

Faisal Khan, PhD, the director of the health department in St. Louis County, Mo., told Kaiser Health News that while monitoring programs can lead to an increase in overdose deaths in the years immediately following their establishments, they also help physicians intervene before a patient becomes addicted to opioids. 

He said physicians can direct patients to treatment programs, but Rachel Winograd, PhD, who leads a program called NoMODeaths, said "we absolutely are not prepared for that in Missouri." Ms. Winograd told Kaiser Health News substance use treatment providers are often at max capacity.

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