Background: Prescription drug monitoring programs (PDMP) provide medication-related information about high-risk medicines to support clinical decision-making. This study aims to determine how PDMP alerts and other patient, pharmacy and medication-related characteristics influence pharmacists’ decisions to supply opioids.
Methods: Australian pharmacists completed an online randomised controlled factorial experiment. They were randomly allocated six clinical vignettes, describing a pharmacy patient and asked to indicate on a 0-10 scale, how likely they were to supply the opioid prescription within the vignette. Mixed-effects linear regression models were used to explore the association between vignette and pharmacy-related characteristics and the likelihood to supply opioids. Results: 598 pharmacists provided data relating to 3370 vignettes. The high-dose and multiple prescribers (4 or more prescribers in the past 3 months) PDMP alerts were the strongest predictors of reduced likelihood to supply, with a respective 2.8- and 3.8-unit decrease on the likelihood to supply scale (p=0.001). Unemployment (β=-0.42, p<0.001), and comorbidities of Hepatitis C (β=-0.26, p=0.009) and Depression (β=-0.30, p=0.003) were also significantly associated with decreased likelihood to supply opioids. Medication-related characteristics including high opioid dose (40mg twice daily) and a co-prescription of opioids with benzodiazepines saw a reduced likelihood to supply of 0.26- and 0.48-units, respectively. Implications: PDMP alerts were the most influential factor associated with reduced likelihood to supply, while other factors associated with economic disadvantage and stigma were also associated with a reduced likelihood to supply. It is important that PDMP-related unintended consequences observed elsewhere, including medication refusal or rapid tapering, are avoided locally.
Dr Louisa Picco is an NHMRC Emerging Leader Research Fellow at the Monash Addiction Research Centre in Melbourne, Australia. Her research areas of interest include identifying and responding to prescription opioid related risks and harms, particularly through the implementation of prescription drug monitoring programs.