Drug monitoring programs, naloxone among focus areas of public health report

A multidisciplinary panel of experts that convened last year to address the prescription opioid crisis has issued its official report of recommendations, including a call for mandated use of prescription drug monitoring programs (PDMPs) by providers and moves to facilitate wider availability of the overdose reversal drug naloxone.

The discussions that led to the report were initiated at a 2014 forum co-hosted by the Johns Hopkins Bloomberg School of Public Health and the Clinton Health Matters Initiative. The report, The Prescription Opioid Epidemic: An Evidence-Based Approach, covers topics such as physician training, prescription protocols, overdose response, and addiction treatment.

“A comprehensive response to this crisis must focus on preventing new cases of opioid addiction, identifying early opioid-addicted individuals, and ensuring access to effective opioid addiction treatment while safely meeting the needs of patients experiencing pain,” the report's executive summary states.

Two of the seven areas of recommendations that are arguably the most hard-hitting of the proposals cover PDMPs and overdose education/prevention. The report calls for mandated PDMP use by prescribers of opioids; lagging participation has hampered the effectiveness of some states' programs, which are designed to uncover problematic opioid use. One study found that even among physicians who reported accessing PDMP data at some point, they did so in less than one-quarter of the instances in which they were prescribing an opioid to a patient.

The report adds that third-party payers, including private health plans and the Medicaid and Medicare systems, should be authorized to access PDMP data, with proper safeguards built in. In addition, the report suggests that health professional licensing boards should be given the OK to investigate high-risk prescribers of opioids.

In the area of overdose prevention, the panel has recommended efforts toward making naloxone formulations easier to use by non-medical individuals, and less costly. Also, the field should engage health professionals to bring about consensus guidelines for the co-prescription of opioids and the life-saving naloxone, the report states. Some health systems, including at the Department of Veterans Affairs (VA), have begun implementing campaigns to increase the co-prescription of naloxone with pain medication.

“This is a complex epidemic with no simple solutions,” G. Caleb Alexander, MD, co-director of the Johns Hopkins Center for Drug Safety and Effectiveness, said in a Nov. 16 news release. “We tried to identify as many windows as possible, and to tie together as much research as available, to inform these recommendations which together we believe provide the best chance of turning this steamship around.”

The report will be among the topics discussed at a Nov. 17 forum hosted by the Bloomberg School and the Clinton Health Matters Initiative. The first hour of the event, starting at 3 p.m. Eastern time, will be live-streamed.