The Impact of Prescription Drug Monitoring Programs and Prescribing Guidelines on Opioid Prescribing Behaviors: A Time for Institutional and Regulatory Changes

The rising rate of prescription opioid misuse, abuse, and opioid-related fatalities has prompted the development of a number of guidelines for prescribing opioids to patients with chronic noncancer pain, including the recently published US Centers for Disease Control and Prevention Guidelines for Prescribing Opioids for Chronic Pain [1]. These guidelines outline a number of core opioid risk mitigation strategies. These strategies include use of controlled substance agreements when initiating long-term opioid therapy, urine drug monitoring, limiting the supply and dosing of opioids, and employing state prescription drug monitoring programs (PDMP). Pomerleau and colleagues [2] conducted a multicenter, cross-sectional web-based survey of emergency department (ED) providers on opioid prescribing practices. Respondents were queried about their decisions regarding opioid prescribing and their use and knowledge of opioid prescribing guidelines and PDMPs. Results of the survey revealed that only 59% of the respondents were registered to access the PDMP in their respective states and 5% were unaware of whether their state had a PDMP. Only 40% of the study cohort used opioid prescribing guidelines; 24% did not, and 35% were not cognizant of the guidelines. Lastly, 16% of the respondents acknowledged that they prescribed an opioid to expedite discharge from the ED, and 12% prescribed an opioid to improve patient satisfaction scores.