Prescription Drug Overdose

PSR NATIONAL SUMMARY

Icon of a drug capsule in front of a prescription bottle

The Prevention Status Reports highlight—for all 50 states and the District of Columbia—the status of public health policies and practices designed to address 10 important public health problems and concerns.

CDC and other agencies continue to identify and evaluate interventions to reduce prescription opioid overdose deaths. This report focuses on two key policies concerning state prescription drug monitoring programs (PDMPs), electronic systems that track the dispensing of controlled substances to patients. The following policies are supported by emerging evidence, expert consensus, and extensive review of the primary drivers of the epidemic (1–3):

Requiring timely data submission to the PDMP
Requiring universal PDMP use by prescribers

These policies are especially promising but are not the only interventions needed to address this epidemic. Rather, they should be seen as key pieces in a much larger, multisector approach to preventing prescription drug abuse and overdose. Other important PDMP practices for states to consider include ensuring that their PDMP 1) is easy to use and access (e.g., by allowing delegates of the provider to access the system); 2) can be linked to electronic health records for point-of-care decision making by providers; 3) is accessible to public health agencies for tracking trends; and 4) has the capacity to proactively notify users of high-risk behaviors (1). Also, the Department of Health and Human Services outlines three priority areas to advance a comprehensive approach to reversing the epidemic: improving opioid prescribing practices, expanding use and distribution of naloxone, and expanding medication-assisted treatment to reduce opioid use disorders and overdose (2).

Requirement for timely data submission to prescription drug monitoring program

State-required interval between dispensing a controlled substance and submitting the dispensing data to the state PDMP.

Bar chart showing the number of states rated green, yellow, and red for requirement for timely data submission to prescription drug monitoring program in the 2015 PSRs, along with a table showing the rating scale. In 2015, of states with available data, 24 states rated green, 23 states rated yellow, and 4 states rated red. Green means the state dispensing data submission requirement is within 24 hours. Yellow means the state dispensing data submission requirement is more than 24 hours but within one week. Red means state dispensing data submission requirement is more than one week or no reporting requirement. States with missing data are not included. (State count includes the District of Columbia.)

How These Ratings Were Determined
These ratings reflect data provided by the National Alliance of Model State Drug Laws about state legal requirements for the timeliness of data submission to state PDMPs. CDC translated this information into a rating for each state. The rating does not reflect how fully the state has carried out the law. The “as of” date referenced in the Prescription Drug Overdose state reports—July 31, 2015—is the date CDC assessed the law. The date does not reflect when the law was enacted or became effective.

Requirement for universal use of state prescription drug monitoring program

State requirement that prescribers must consult the patient’s PDMP history before initially prescribing opioid pain relievers and benzodiazepines, and at least every three months thereafter.

Bar chart showing the number of states rated green, yellow, and red for requirement for universal use of state prescription drug monitoring program in the 2015 PSRs, along with a table showing the rating scale. In 2015, of states with available data, 4 states rated green, 4 states rated yellow, and 43 states rated red. Green means prescribers are required to consult the PDMP before initial opioid and benzodiazepine prescriptions and at least every three months thereafter. Yellow means prescribers are required to consult the PDMP before initial opioid prescriptions and again within one year. Red means prescribers are not required to consult the PDMP before initial opioid prescriptions, or such a requirement does exist but there is no required subsequent check and/or the policy includes subjective standards or broad exceptions. States with missing data are not included. (State count includes the District of Columbia.)

How These Ratings Were Determined
These ratings reflect data provided by the National Alliance of Model State Drug Laws and the PDMP Center of Excellence at Brandeis University about state laws requiring prescriber use of state PDMPs. CDC translated this information into a rating for each state. The rating does not reflect how fully the state has carried out the law. The “as of” date referenced in the Prescription Drug Overdose state reports—October 31, 2015—is the date CDC assessed the law. The date does not reflect when the law was enacted or became effective.

For the purposes of this report, a law was deemed to “require” a PDMP check when it applied to most or all prescribers. To be rated green, a state’s policy must have required a check for both opioid and benzodiazepine prescriptions; to be rated yellow, the requirement must have applied to at least opioid prescriptions.

Laws were considered to be requiring a PDMP check even if they had limited exceptions to the requirement (e.g., exempting prescriptions written in emergency departments) or if they exempted short prescriptions (i.e., lasting less than seven days). Laws that applied only to limited classes of providers (e.g., only opioid treatment programs or pain clinics) or that had overly broad exceptions (e.g., exempting prescriptions lasting 90 days or less), were not deemed as requiring PDMP checks in this report and were rated as red. In addition, laws in which the requirement depended on a subjective standard (e.g., the provider was required to check the PDMP only when having a reasonable belief of inappropriate use by the patient or only when treating chronic pain) were rated red.

**State count includes the District of Columbia