Robust Prescription Monitoring Programs and Abrupt Discontinuation of Long-term Opioid Use

Used by health care providers, public health officials, and other stakeholders, PDMPs have become a major tool in addressing unsafe opioid prescriptions. Robust features of PDMPs—including mandates that allow prescriber use of PDMP, data-sharing across states, and prescriber delegation of PDMP access to office staff—are implemented to improve the use of the database. While these features are intended to reduce high-risk opioid use, patients receiving long-term opioid therapies may experience unintended consequences of these policies if their long-term use is discontinued without appropriate tapering, leading to opioid withdrawal and uncontrolled pain.

CHERISH investigators Yuhua Bao and Bruce Schackman, pilot grant recipient Hao Zhang, CHERISH Research Affiliate Katherine Wen, and colleagues at Cornell University and Weill Cornell Medicine conducted this study to determine if the implementation of robust features of PDMPs was associated with abrupt discontinuation of long-term opioid therapies. Using national insurance claims data from the Health Care Cost Institute, the authors identified long-term opioid users among privately insured adults aged 18 to 64 and enrollees of Medicare Advantage plans aged 65 and above. The authors defined the robustness of PDMPs—non-robust, robust, and strongly robust—based on a combination of state legislations and practices regarding PDMP use. They measured abrupt discontinuation of long-term opioid therapies based on the presence or absence of dose tapering over the last 60 days of the long-term therapy.

The authors found that robust PDMP policies were not associated with substantial increases in abrupt discontinuation of long-term opioid therapies. In fact, the findings suggest that strongly robust PDMPs may have been protective for older Medicare Advantage patients in the sense that the policies were associated with a lower likelihood that these patients discontinued long-term therapies at a high dose. The authors found that an overwhelming majority of long-term opioid therapies discontinued without tapering and suggested further research to address barriers to tapering.