Alex Cohen is the Director of Learning and Evaluation for the Richard M. Fairbanks Foundation.
A patient visits a doctor. He suffers from chronic pain. In fact, he’s been suffering for a while, and he’s been receiving painkillers for months. And recently, he’s been upping his dosage and visiting multiple doctors to get enough.
But the doctor he’s seeing today doesn’t know this. If she knew about his prescription history, she might engage him in a conversation about his opioid use, suggest alternative pain remedies or even refer him to substance abuse treatment.
Instead, she writes him a prescription, and he leaves.
Making patients’ opioid prescription histories readily accessible to healthcare providers has the potential to curb opioid misuse and limit the rising number of overdose deaths in the state.
And last week, Indiana Governor Eric Holcomb announced a plan to make this a reality by merging Indiana’s prescription drug monitoring program (or PDMP), known as INSPECT, with the electronic health records used by doctors and other providers.
But while this is certainly a critical step, easing provider access to this information doesn’t on its own lead to reductions in the misuse of opioids or overdoses. That requires at least three things to occur.
First, the prescribing data from INSPECT must be easily accessible and routinely seen by doctors and other prescribers.
In other states, Appriss, the company developing the new system for Indiana, has put substantial effort into collapsing a large amount of data on past prescriptions into a quickly readable interface for doctors.
Putting requirements that encourage doctors to view this information will also likely be important.
A recent study found that in states that installed “must access” PDMPs—which required providers to review a patients’ opioid prescribing—saw substantial declines in opioid prescriptions filled. Those with “weak access” PDMPs—where providers weren’t required to review this information—did not.
Second, providers must know what to do with this information, once they see it.
Suppose a doctor notices that a patient has been “doctor shopping” for opioids. What’s the right thing to do next? It might be necessary to provide education on prescribing recommendations, based on what providers see in a patient’s opioid prescription history (for example, using CDC prescribing guidelines). Or there may be scope for providers to learn more about alternative pain remedies or brief interventions with patients around substance use disorder.
Third, and perhaps most importantly, there must be adequate access to evidence-based treatment, including MAT. If access to treatment is limited, then identifying individuals with opioid use disorder won’t make much of a difference on patient outcomes.
The study of the impact of “must access” vs. “weak access” PDMPs had one more finding: Even in those states with “must access” PDMPs, which saw substantial declines in opioid prescriptions, there was no noticeable impact on opioid overdose deaths. As the study’s authors note, one possible explanation is lack of access to treatment.
To be most effective, making patients’ prescription histories available to providers will likely require complementary investments like provider incentives, prescriber education and access to treatment. The strategies set forth by the Indiana Commission to Combat Drug Abuse and efforts to expand access to MAT will go a long way toward ensuring these complementary investments occur.
And like the state, the Richard M. Fairbanks Foundation is focused on tackling the opioid epidemic through a multi-pronged approach that includes expanding access to evidence-based prevention programs, substance use disorder treatment and harm reduction tools like naloxone and needle exchanges. Our hope is that these efforts will work in concert to lower misuse of opioids and stem the tide of rising overdose deaths in Marion County and throughout the state.