When Prescribers Use PDMP Data

1. When Prescribers
Use PDMP Data
Presenters:
• Sara Hallvik, MPH, Healthcare Analyst Manager, Acumentra Health
• Christi Hildebran, LMSW, CADC III, Research Manager, Acumentra Health
• Cynthia Reilly, Director, Prescription Drug Abuse Project, The Pew Charitable
Trusts
• John L. Eadie, Coordinator, Public Health and Prescription Drug Monitoring
Program Project, National Emerging Threat Initiative, National HIDTA
Assistance Center
PDMP Track
Moderator: Anne L. Burns, RPh, Vice President, Professional Affairs,
American Pharmacists Association, and Member, Rx and Heroin
Summit National Advisory Board

2. Disclosures
John L. Eadie; Sara Hallvik, MPH; Christi
Hildebran, LMSW, CADC III; Cynthia Reilly; and
Anne L. Burns, RPh, have disclosed no relevant,
real, or apparent personal or professional
financial relationships with proprietary entities
that produce healthcare goods and services.

3. Disclosures
• All planners/managers hereby state that they or their
spouse/life partner do not have any financial
relationships or relationships to products or devices
with any commercial interest related to the content of
this activity of any amount during the past 12 months.
• The following planners/managers have the following to
disclose:
– John J. Dreyzehner, MD, MPH, FACOEM – Ownership
interest: Starfish Health (spouse)
– Robert DuPont – Employment: Bensinger, DuPont &
Associates-Prescription Drug Research Center

4. Learning Objectives
1. Explain the benefits when prescribers use
PDMP data.
2. Outline evidence-based practices that
increase prescriber utilization of PDMPs.
3. Compare opioid prescribing patterns before
and after provider registration with the
Oregon PDMP.
4. Provide accurate and appropriate counsel as
part of the treatment team.

5. Christi Hildebran, LMSW, CADC III
Sara Hallvik, MPH
Acumentra Health
Portland, Oregon
When Prescribers Use PDMP Data
Opioid Prescribing Before and
After PDMP Registration

6. Disclosure Statement
Christi Hildebran, LMSW, CADC III, and
Sara Hallvik, MPH,
have disclosed no relevant, real or apparent
personal or professional financial relationships
with proprietary entities that produce health care
goods and services.

7. Learning Objectives
1. Explain the benefits when prescribers use
PDMP data.
2. Outline evidence-based practices that
increase prescriber utilization of PDMPs.
3. Compare opioid prescribing patterns
before and after provider registration
with the Oregon PDMP
4. Provide accurate and appropriate counsel
as part of the treatment team.

8. National Institutes of Health
Funded Study
“Use of Prescription Monitoring Programs
to Improve Patient Care and Outcomes”
Supported by the National Institutes of Health, National Institute for Drug Abuse through
Grant #1 R01 DA031208-01A1, and by the National Center for Research Resources and the
National Center for Advancing Translational Sciences, through grant UL1RR024140.

9. Background
• PDMPs increasingly used for public health:
reduce drug abuse, improve patient safety
• Many clinicians who prescribe
controlled drugs do not use PDMPs
• Little is known about the impact of
PDMP use on prescribing practices and patient
outcomes

10. Oregon PDMP History
• Oregon PDMP became operational in
September 2011.
• Oregon PDMP is paid for by an annual fee of
$25 that is included in board licensee fees of
prescribers and pharmacists.
• NIH grant to study Oregon’s PDMP awarded in
February 2012.

11. Oregon PDMP Profile
• Optional registration and use
• User must pull query information from website
(no push notifications or unsolicited reports)
• Providers’ experience of using PDMP is mixed
– time constraints in accessing the system
– cannot delegate access
– system difficult to access and navigate
– frequent password changes
– provides objective evidence of patient’s
prescription history

12. PDMP Registration by Type
Delegates
MD / DO
NP / PA
DDS/DMD
RPh
0
1000
2000
3000
4000
5000
6000
Q42011
Q12012
Q22012
Q32012
Q42012
Q12013
Q22013
Q32013
Q42013
Q12014
Q22014
Q32014
Q42014
Q12015
Q22015
Q32015
Q42015
NumberofSystemAccounts
Cumulative system accounts by quarter and discipline

13. State Policy Changes During Study
Time Period
• Beginning in 2012, there were new financial
arrangements (CCOs), guidelines and
authorizations required by Medicaid.
• Regional Pain Collaborative developed across
the state.
• Delegated access in effect as of January 2014.
• System interface upgraded in 2014.

14. Study Aims
Understand the prescribing differences between
registered prescribers and non-registered prescribers
and how their patient outcomes differ. Does use of
the PDMP improve patient outcomes?
Hypothesis
Providers who register for PDMP will reduce
prescribing and prescribe more safely after
registering to use.

15. Definitions
• Registered User: Prescriber who registers to use the PDMP.
• Non-Registered User: Prescriber who does not register to
use the PDMP.
• Query: Prescriber (or delegate) runs a query in the PDMP to
see a patient’s prescriptions.
• Death*: Identified in vital records (death certificates) with
underlying cause AND contributing cause ICD-10 codes
indicating poisoning by opioids, regardless of intent.
• Overdose hospitalization*: Identified in hospital discharge
registry data with
– Poisoning ICD-9 code, OR
– Adverse effect of opioid ICD-9 code on the same day as a
diagnosis or intent code (e-code) suggestive of overdose.
*Including heroin

16. Methods
• Improved patient linkage within PDMP
• Created clean PDMP dataset, Oct ‘11‒Oct ‘14
– Removed invalid prescriptions and prescriptions
from non-Oregon prescribers
– Augmented classification of drugs; strength and
conversion factor information to calculate MME
• Linked PDMP with statewide hospital
discharge registry and vital records

17. Methods
• Defined a set of measures to describe provider
prescribing practices
• Calculated measures in the 12 months before and
12 months after date of registration, among
providers who registered to use the PDMP
between October 2012 and September 2013
• Used propensity score methods to match each
registered provider (n=1,131) with a non-
registered provider of similar “pre” prescribing
profile (n=1,131)

18. Provider cohorts (registrants and non-registrants)
were very well matched
Prescribing variable used for matching Mean difference*
Number of patients with an opioid prescription .030
Average pills per opioid prescription .050
Average dose (MME) per prescription .028
Average dose (MME) per patient .027
Percent of patients with high dose (MME) .016
Number of benzodiazepine prescriptions .043
*Mean difference is the standardized distance between the “pre” value of
each pair. Values <0.1 indicate negligible differences.

19. Methods
Then we examined:
1. statewide trends in prescribing over time
2. pre-post change in prescribing between matched
registered and non-registered provider cohorts
3. pre-post change in prescribing considering the
number of queries made in PDMP system

20. 1690 1620 1674 1660 1668
1557 1498
800
1000
1200
1400
1600
1800
2000
2200
2400
Q4
2011
Q1
2012
Q2
2012
Q3
2012
Q4
2012
Q1
2013
Q2
2013
Q3
2013
Q4
2013
Q1
2014
Q2
2014
Q3
2014
Number of opioid units (pills) dispensed per 100
population
 Volume of opioids in the state decreased over time

21. 0.71 0.70 0.71 0.70 0.69
0.64 0.61
0.30
0.40
0.50
0.60
0.70
0.80
0.90
1.00
Q4
2011
Q1
2012
Q2
2012
Q3
2012
Q4
2012
Q1
2013
Q2
2013
Q3
2013
Q4
2013
Q1
2014
Q2
2014
Q3
2014
Number of patients with a quarterized MME greater than or
equal to 100MME per 100 population
 Chronic high dose of opioids decreased over time

22. 0.11 0.11 0.10 0.10 0.09 0.09 0.09
0.00
0.05
0.10
0.15
0.20
Q4
2011
Q1
2012
Q2
2012
Q3
2012
Q4
2012
Q1
2013
Q2
2013
Q3
2013
Q4
2013
Q1
2014
Q2
2014
Q3
2014
Number of inappropriate prescriptions* per 100
population
 Inappropriate prescribing decreased over time
*same medication within 7 days from a different prescriber

23. 0.80
0.76 0.77 0.76
0.73
0.67 0.64
0.40
0.50
0.60
0.70
0.80
0.90
1.00
1.10
Q4
2011
Q1
2012
Q2
2012
Q3
2012
Q4
2012
Q1
2013
Q2
2013
Q3
2013
Q4
2013
Q1
2014
Q2
2014
Q3
2014
Number of methadone Rx per 100 population
 Volume of methadone decreased over time

24. 11.0 11.0
9.3
10.3 10.2 9.8 10.1
0.9
1.5 1.6 1.7 1.2 1.7 1.5
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
Q4
2011
Q1
2012
Q2
2012
Q3
2012
Q4
2012
Q1
2013
Q2
2013
Q3
2013
Q4
2013
Q1
2014
Q2
2014
Q3
2014
Statewide opioid-related overdose deaths and
hospitalizations per 1,000 population
Overdose Hospitalizations Overdose Deaths
 Overdose hospitalizations and deaths remained steady
over time

25. Time Trend Results
• General downward trend in per capita
prescribing
• Stagnant per capita death and hospitalization
overdose rates
Hypothesis
• Providers who register for PDMP will reduce
prescribing and prescribe more safely after
registering.

26. Pre–Post Change in Prescribing Patterns
Prescribing pattern Registered Non-registered p-value
n 1,131 1,131
Change Change
Number of opioid prescriptions 91.5 -8.6 <.0001
Number of patients with an opioid prescription 33.2 -2.1 <.0001
Dose (MME) per patient 2.14 -1.71 .0023
Pills per opioid prescription 4.6 -2.6 <.0001
Number of methadone prescriptions 4.1 -0.2 .0006
Number of benzodiazepine prescriptions 24.4 -4.1 <.0001
Percent of opioid prescriptions with a sedative-
hypnotic or carisoprodol prescription within 30 days
.018 .005 .0005
Number of inappropriate prescriptions .054 -.005 .0355
• Registered providers increased prescribing after registration
• Non-registered provider pairs decreased prescribing in the
same time period

27. Pre-Post Change in Prescribing Patterns Among
Registered Prescribers, According to Query Frequency
Prescribing pattern
Top quartile of
PDMP users
Bottom quartile
of PDMP users p-value
n 282 342
Change Change
Number of opioid prescriptions 144.92 -6.34 <.0001
Number of patients with an opioid prescription 61.01 -1.11 <.0001
Dose (MME) per patient 3.71 -2.29 <.0001
Pills per opioid prescription 11.50 -1.86 <.0001
Number of methadone prescriptions 7.95 -1.13 .0054
Number of benzodiazepine prescriptions 32.47 4.72 <.0001
Percent of opioid prescriptions with a sedative-
hypnotic or carisoprodol prescription within 30 days
.036 .005 .0003
Number of inappropriate prescriptions .106 -.003 .0099
• Prescribers who use the PDMP the most increased prescribing
after registering
• Prescribers who registered but never use the PDMP decreased
prescribing after registering

28. Patient Overdose Outcomes, According to
Registration Status of Prescribers
Patients whose
providers were ALL
REGISTERED
Patients with
AT LEAST ONE
REGISTERED provider
and AT LEAST ONE
NON-REGISTERED
provider
Patients with
NO REGISTERED
providers
N (%) N (%) N (%)
Total in the PDMP 540,889 663,059 517,132
Overdose death 150 (0.03%) 335 (0.05%) 70 (0.01%)
Overdose
hospitalization 1,045 (0.19%) 5,173 (0.78%) 519 (0.10%)
p-val
Any overdose event 1,195 (0.22%) 5,508 (0.83%) 589 (0.11%)
<.0001
No overdose events 539,694 (99.78%) 657,551 (99.17%) 516,543 (99.89%)

29. Conclusions
• Following implementation of Oregon’s PDMP,
there was a statewide decline in:
– per capita number of inappropriate prescriptions
– MME dispensed
– number of pills dispensed
• Despite the changes, the number of opioid-
related deaths and overdose hospitalizations
remained stable.

30. Conclusions
• Contrary to our hypotheses, prescribers
who registered for the PDMP did NOT
appear to decrease prescribing. In fact, they
prescribed more.
• This trend was most apparent among
registrants who made greatest use of the
PDMP.

31. Conclusions
• Among prescribers who did NOT register for
the PDMP, there were decreases in
prescribing.
• Non-registered prescribers, who
outnumbered registered prescribers
roughly 10:1, may have accounted for the
statewide trends.

32. Conclusions
• Number of patients and number of prescriptions
increased among registered prescribers, and
decreased among non-registered prescribers.
• Possible migration of patients from non-
registered to registered prescribers who were
most likely to use the PDMP, and perhaps most
liberal in prescribing.
• Migration might account for some increases in
prescribing among registered prescribers.

33. Conclusions
• Overall statewide decline in opioid prescribing may
have resulted from a “surveillance effect,” in which
prescribers perceived that their prescribing
patterns were being scrutinized.
• Other factors in the environment were likely
important, such as greater reporting of opioid
prescribing and related mortality in the media and
professional publications, new clinical guidelines,
new reimbursement restrictions from Medicaid.

34. Study Limitations
• Generalizable to states similar to Oregon:
states without mandatory registration or
PDMP use, nor proactive alerts.
• Selection bias: providers who register for
and use PDMP may have different treatment
goals / patient panels.
• Difficult to parse out influence of PDMP from
current environmental factors in prescribing.

35. Next Steps for PDMP Administrators
and Health Plans
• Refinements in the program and supplementary policies
may be necessary to improve the PDMP’s impact.
• Refinements might include the use of proactive alerts,
mandatory registration, mandatory querying for new
opioid prescriptions, and better training of clinicians in
use of this relatively new innovation.
• Supplementary policies might include preauthorization
for high-dose prescriptions or initial prescriptions for
long-acting opioids, and “pill mill” laws.
*Many of these have been implemented in other states.

36. Next Steps for PDMP Research
• Determine what factors influence the increase
in prescribing, especially risky prescribing,
among those who use the PDMP.
• Understand how refinements to Oregon’s
PDMP (e.g., mandatory use, proactive alerts)
might affect prescribing patterns and
ultimately patient care and outcomes.

37. Contact Information
Christi Hildebran
 childebran@acumentra.org
Sara Hallvik
 shallvik@acumentra.org
Project Funding:
National Institute on Drug Abuse, 1R01DA031208-01A1
For more information, please visit
http://www.acumentra.org/PDMP/

38. Optimizing Prescriber Use of
PDMP Data, Part 1
National Prescription Drug Abuse & Heroin Summit
March 30, 2016
Cynthia Reilly, B.S. Pharm.
Director, Prescription Drug Abuse Project
The Pew Charitable Trusts

39. The Pew Charitable Trusts’
Prescription Drug Abuse Project
Goal: To help reduce the inappropriate use of prescription
drugs while ensuring that patients with legitimate
medical needs have access to effective pain control
– Expand the use of management tools, such as patient
review and restriction programs, in Medicaid and
Medicare
– Reduce the use of methadone for pain control in state
Medicaid programs
– Improve state prescription drug monitoring programs

40. Pew’s PDMP-Related Activities
• Fall 2012 - Prescription Drug Monitoring Programs: An
Assessment of the Evidence for Best Practices
• April 2015 - A Five-Year Roadmap: Optimizing State
Prescription Drug Monitoring Programs from 2015 to
2020
• May 2015 - PDMP Research Forum: Identifying Priorities
to Optimize Use and Improve Public Health
• October 2015 - Is Poor Data Quality Impeding PDMP
Effectiveness? A Discussion Exploring Critical Data Quality
Issue
• June 2016 - Optimizing Prescriber Utilization of
Prescription Drug Monitoring Programs: Evidence-Based
Practices and Strategies for Implementation

41. “…PDMPs are unlikely to
reach their full potential in
reducing prescription drug
misuse and abuse and
diversion if they are not
utilized.”
Office of National Drug
Control Policy, 2015
https://www.whitehouse.gov/sites/default/files/ondcp/policy-and-research/2015_national_drug_control_strategy_0.pdf

42. • On October 21, 2015, President Obama announced actions
to address the prescription drug abuse and heroin epidemic
• Included a commitment by federal, state, local governments
and the private sector to double the number of health care
providers registered with their state PDMPs by 2017
https://www.whitehouse.gov/the-press-office/2015/10/21/
fact-sheet-obama-administration-announces-public-and-private-sector

43. Optimizing Prescriber Utilization of Prescription Drug
Monitoring Programs:
Evidence-Based Practices and Strategies for
Implementation
• Unsolicited Reporting
• Prescriber Use Mandates
• Delegation
• Data Timeliness
• Streamlined Enrollment
• Educational and Promotional Initiatives
• Health Information Technology Integration
• Enhanced User Interfaces

44. Key Questions
• What is the evidence demonstrating effectiveness of these
practices?
• How are states implementing these practices?
• What implementation barriers were encountered and how
were they overcome?
• What was the impact on PDMP resources?
• What is the extent of adoption of these practices by PDMPs
nationwide?

45. Strategies for Implementing Change
• Assess current status
• Analyze facilitators and barriers to change
• Prioritize goals
• Develop strategic plan
• Implement
• Assess
• Modify, if needed

46. “PDMPs are more than just passive databases.”
Centers for Disease Control and Prevention
http://www.cdc.gov/drugoverdose/pdmp/states.html

47. Unsolicited Reports
•Proactive communications that alert users about
potentially harmful drug use or prescribing
activity based on the data contained in the PDMP
• Based on thresholds associated with increased risk of
harm or abuse
• Notifications may be sent to:
– Prescribers
– Dispensers
– Regulatory agencies
– Law enforcement

48. Massachusetts’ Assessment of
Unsolicited Reporting
• MA transitioned to electronic alerts in December 2013
• Initial results:i
– 21 percent of prescribers who received an alert logged into
the PDMP for the first time
– 59 percent of patients who were the subject of an alert sent
the first month did not meet the threshold again for the next
six months
– Prescriber survey (n = 87)
• Only 24 percent were aware of all other prescribers providing
controlled substances to their patients
• 85 percent said viewing PDMP data increased
confidence in prescribing decisions
ihttp://www.pdmpexcellence.org/sites/all/pdfs/MA%20PMP%20electronic%20alert%20NFF.pdf

49. Massachusetts’ Assessment of
Unsolicited Reporting (cont’d)
http://www.pdmpexcellence.org/sites/all/pdfs/MA%20PMP%20electronic%20alert%20NFF.pdf

50. Maine’s Progression in Use of
Unsolicited Reports
• ME began sending unsolicited reports in 2005 via U.S.
mail on a quarterly basis
• Electronic alerts now sent via e-mail on a monthly
basis; mailed to unregistered prescribers
• 2009 survey of prescribersi
• Respondents who received an unsolicited report were
significantly more likely to register with the database (73
percent) than those who did not receive the reports (27
percent)
• In 2014, added feature allowing prescribers to set
their own thresholds
ihttp://digitalcommons.library.umaine.edu/cgi/viewcontent.cgi?article=1020&context=ant_facpub

51. Maine’s Progression in Use of
Unsolicited Reports (cont’d)
ihttp://digitalcommons.library.umaine.edu/cgi/viewcontent.cgi?article=1020&context=ant_facpubhttp://www.pdmpassist.org/pdf/PPTs/National2012/2_Allain_StatePanelInnovationsIndiana.pdf

52. Indiana’s User-Led
Unsolicited Reports
• In 2012, IN was one of the first states to launch “user-
led” unsolicited reportsi
• Reports generated by PDMP-registered prescribers and
sent to peers who prescribe to the same patient
• Used information from licensing boards to email reports to
non-registrants—includes enrollment instructions
• In the first two months, 68 percent of user-led
reports were sent to individuals not enrolled in the
PDMPi
• Provides mechanism to promote registration and use
ihttp://www.pdmpassist.org/pdf/PPTs/National2012/2_Allain_StatePanelInnovationsIndiana.pdf

53. PDMPs Authorized, Engaged in
Sending Unsolicited Reports to Prescribers
67%
80%
30%
66%
25%
35%
45%
55%
65%
75%
85%
2006 2015
Authorized Engaged
http://www.kms.ijis.org/db/share/public/PMIX/ijis_pmix_survey_ta_report_20070204.pdf;
http://www.namsdl.org/library/BDC14250-C636-4E06-3EA3510BB665BF67/;The Pew
Charitable Trusts and the Prescription Drug Monitoring Program Center of Excellence at
Brandeis University, unpublished data.

54. Thank You
Cynthia Reilly, B.S. Pharm.
Director, Prescription Drug Abuse Project
The Pew Charitable Trusts
creilly@pewtrusts.org
202-540-6916
www.pewtrusts.org/en/projects/prescription-drug-abuse-project

55. Optimizing Prescriber Use of
PDMP Data, Part 2
National Prescription Drug Abuse & Heroin Summit
March 30, 2016
John Eadie, MPA
Director, PDMP Center of Excellence
Brandeis University

56. Origin of Prescriber Mandates to Use
PDMPs
• Nevada law in 2007: Subjective Judgment
– When prescriber believed patient trying to obtain
drugs for non-medical reason.
– Increased from 4 to 19 annual requests per
prescriber.
• Other states followed with subjective
mandates in specific circumstances

57. Comprehensive Prescriber Use Mandates
• Kentucky tried to increase voluntary prescriber
use for 13 years by education.
– By 2012 -- 27 annual requests per prescriber.
– Found this inadequate.
• First comprehensive mandate in 2012: Law and
Regulation
– Must request PDMP data prior to initial Rx for drugs in
C-II, III and IV.
– Must request again at least every 3 months for opioids
for pain and annually for other C-II, III and IV drugs.

58. Comprehensive Use Mandates – 1
As of February 2016:
14 states have enacted comprehensive mandates
State – Effective Date
• KY – July 2012
• TN – April 2013
• WV - May 2013
• NY – August 2013
• NM – April 2014
• OH – April 2015
• CT – July 2015
State – Effective Date
• PA – June 2015
• NV – October 2015
• NJ – November 2015
• OK – November 2015
• RI – March 20I5
• MA – January 2016
• NH – September 2016

59. Comprehensive Use Mandates - 2
• Comprehensive mandates are objective:
– Apply to all prescribers
– Apply at least for all initial opioid prescriptions.
– Drugs included:
• All Schedule II, III and IV – 5 states
• Opioids and benzodiazepines – 5 states
• Opioids only – 3 states
• Schedule II drugs for acute or chronic pain – 1 state

60. Comprehensive Use Mandates – 3
• Triggering events:
– Initial Prescription for included drugs – 14 states
– For continued treatment:
• All prescriptions – 1 state
• At least every 90 days - 4 states
• At least every 6 months – 3 states
• At least annually – 3 states
• No follow-up required – 3 states

61. Comprehensive Use Mandates – 4
Exceptions to Mandates – most common:
• Short duration prescriptions:
• 5 days or less if issued in Emergency Dept. – 3 states
• 7 days or less – 3 states
(in 1 – excepted only if no refills)
• 10 days or less – 1 state
• Terminally Ill Patients
• Terminal Illness – 6 states
• Terminal illness & under hospice care – 2 states
• Hospital or long term care in patients – 7 states
• If PDMP is inaccessible, e.g. electrical failure – 5
states

62. Provision for Prescriber Delegates
• Delegates can obtain PDMP reports for
prescribers, when state law permits.
• Prescribers set up subaccounts
• Prescribers can audit delegates’ use.
• Prescribers are accountable for delegates’ use.
• All states with comprehensive prescriber use
mandates permit delegates.
• By 2015, 40 states permit delegates.

63. Impact of Comprehensive Prescriber
Use Mandates
• KY, OH and NY are tracking multiple measures
to understand the impact of mandates
• The University of Kentucky assessed the
impacts through the end of the first year, until
July 2013.
– UK study available at: http://www.chfs.ky.gov/os/oig/KASPER.htm

64. University of Kentucky Evaluation of
Mandate – First year - A
• Pharmacist registrations increased 322% &
queries increased by 124%.
• Prescriber registration increased 262%.
• Mean annual queries per prescriber increased
550 percent, from 34 queries in 2009 to 221 in
2013.
– Increase continued thereafter – see next slide.

65. Reports Requested Kentucky PDMP:
2005 through 2015

66. University of Kentucky Evaluation of
Mandate – First year - B
• Both opioid and benzodiazepine prescribing
decreased.
• A reduction in CII – CIV Rx from 4 to 8%.
– Reduction continued thereafter – decrease is 10%
by end of 2015 see next slide.
• But a “chilling effect” on opioid prescribing did
not appear.

67. Kentucky Rx Submitted to PDMP:
2005 through 2015
http://www.chfs.ky.gov/NR/rdonlyres/E5FDF281-27D7-44D4-8A60-D66A800A6A70/0/KASPERQuarterlyTrendReportQ42015.pdf

68. University of Kentucky Evaluation of
Mandate – First Year - C
• High-dose oxycodone Rx decreased.
• # patients receiving Rx for combination of an
opioid, benzodiazepine, and muscle relaxant,
decreased by 30%.
• Hospital discharges and deaths decreased.
• While increase in heroin discharges and deaths
increased, that started a year before HB1.
• Doctor Shopping decreased by over 50%.

69. New York State - A
• Registered prescribers increased by 77%
within 6 months.
• Registered pharmacists increased 680% in the
same period.
• Requests for reports increased from an
average of 11,000 per month to 1.2 million
per month within 6 months.

70. New York State - B
• Opioid Rx decreased by 8.72%, and individuals
receiving an opioid Rx decreased by 10.4%.
• Yet, Rx for opioids commonly used in chronic
cancer pain treatment (e.g. morphine and
fentanyl) were not adversely affected.
• Buprenorphine prescriptions, used in treating
opioid addiction, increased (14.6%) and the # of
patients with this drug increased (12.8%) in the
fourth quarter of 2013 as compared to the same
quarter in 2012.

71. New York State - C
• There was a 79.5% decrease in # of individuals
involved in multiple provider episodes by the
the first full quarter of the mandate (the
fourth quarter of 2013 compared to fourth
quarter of 2012).
• This effect continued so, by the end of 2015
(two years and 5 months) individuals involved
in multiple copy episodes decreased by 91.2%.

72. NY State: Multiple Provider Episodes and PDMP
Report Requests, October 2011- December 2015
Note: Multiple provider episodes defined as patients using five or more prescribers and five or
more dispensers within the month. Source: New York PDMP
0
50
100
150
200
250
300
350
400
0
200,000
400,000
600,000
800,000
1,000,000
1,200,000
1,400,000
1,600,000
1,800,000
Oct2011
Dec2011
Feb2012
Apr2012
Jun2012
Aug2012
Oct2012
Dec2012
Feb2013
Apr2013
Jun2013
Aug2013
Oct2013
Dec2013
Feb2014
Apr2014
Jun2014
Aug2014
Oct2014
Dec2014
Feb2015
Apr2015
Jun2015
Aug2015
Oct2015
Dec2015
NumberofPatientsMeetingMultipleProviderEpisodesThreshold
NumberofPDMPReportRequests
Multiple Provider Episodes and PDMP Report Requests, October 2011 - December 2015
Patients Meeting Multiple
Provider Episode Threshold
PDMP Report Requests

73. Ohio
• Ohio began in 2011 with a subjective mandate.
Some increases in PDMP registrations and
requests for reports followed.
• While persons involved with multiple prescriber
episodes decreased during the first year, that
leveled off and began increasing again.
• Beginning in April 2015, Ohio’s mandate became
comprehensive and impacts similar to KY and NY
are now expected.

74. Contact Information
John Eadie, MPA
Public Health & PDMP Project Coordinator
National Emerging Threats Initiative
National HIDTA Assistance Center
Phone: 518-429-6397
Email: jeadie@brandeis.edu

75. When Prescribers
Use PDMP Data
Presenters:
• Cynthia Reilly, Director, Prescription Drug Abuse Project, The Pew Charitable
Trusts
• John L. Eadie, Coordinator, Public Health and Prescription Drug Monitoring
Program Project, National Emerging Threat Initiative, National HIDTA
Assistance Center
• Sara Hallvik, MPH, Healthcare Analyst Manager, Acumentra Health
• Christi Hildebran, LMSW, CADC III, Research Manager, Acumentra Health
PDMP Track
Moderator: Anne L. Burns, RPh, Vice President, Professional Affairs,
American Pharmacists Association, and Member, Rx and Heroin
Summit National Advisory Board