Prescribing, Prescription Monitoring, and Health Policy

Abstract

While the United States experienced a surge in morbidity and mortality associated with opioid prescriptions after the year 2000, the country has since 2011 been mired in a growing crisis of overdose and addiction in which illicit opioids play a central role. The drastic increase in persons with prescription opioid use, misuse, and opioid use disorder prompted myriad public health and clinical interventions to curtail opioid-related harms. These approaches can be classified into three main categories: (1) curtailing opioid prescribing, (2) monitoring opioid prescribing, and (3) myriad public policies and initiatives to mitigate and treat opioid use, misuse, and opioid use disorder. Since many persons with opioid use disorder started with potentially prescribed opioids, efforts to curtail and control opioid prescriptions emerged as a primary policy response to address opioid-related morbidity and mortality in the United States. Central to these efforts were the landmark “CDC Guideline on Prescribing Opioids for Chronic Pain” issued by the United States Centers for Disease Control and Prevention in 2016. To monitor patients’ receipt of controlled substances, Prescription Drug Monitoring Programs (PDMPs) emerged. PDMPs capture patient-level prescription fill information to inform prescribing and dispensing decisions, and possibly to support clinical intervention. Today, major initiatives are in place to promote treatment of persons with opioid use disorder and to reduce the harm associated with opioid misuse. These include the promotion of medication treatment for opioid use disorder, community and regional interventions to reduce the harm of opioid misuse, and national legislation (e.g., Comprehensive Addiction and Recovery Act) to improve funding for addiction treatment. As the “opioid epidemic” shifts during its evolution to an “opioid addiction epidemic,” these strategies hold promise to reduce, protect, and improve the health of communities.