States that require prescribers to register for prescription drug monitoring programs have seen a reduction in the number of prescriptions issued for Schedule II opioids to Medicaid enrollees by up to 10 percent, according to research from Weill Cornell Medicine investigators.

Drug monitoring programs provide prescribers with an online record of a patient’s history of controlled substance use, and currently operate in every state and the District of Columbia except Missouri. These programs, which track the prescribing and dispensing of controlled prescription drugs, help identify possible misuse.

The study, published April 3 in the journal Health Affairs, found that mandates for prescribers to register with their states’ drug monitoring programs were associated with reductions in Schedule II opioid prescriptions received by Medicaid patients. The finding suggests that a mandate to register could raise prescriber awareness of potential prescription drug misuse among their patients and increase their use of the monitoring program.

“Our findings show that comprehensive mandates of registration for drug monitoring programs could be effective in promoting safer, more contained prescribing of opioids that have the highest potential for misuse and dependence,” said senior author Dr. Yuhua Bao, an associate professor of healthcare policy and research at Weill Cornell Medicine.

The study used data reported by states to the Centers for Medicare and Medicaid Services from 2011 to 2014, including the numbers of prescription drugs and their costs. Specifically, the researchers examined the number of filled prescriptions (including both new prescriptions and refills) and the amount of pre–rebate Medicaid spending on prescription opioids in each quarter per 100 Medicaid enrollees. They found that states with a mandate for prescribers to register with the drug monitoring program saw nearly a 10 percent reduction in Schedule II opioid prescriptions, as well as significant reduction in Medicaid spending on these drugs.

“Even though almost all states have an operating drug monitoring program, actual use is sub–optimal,” Dr. Bao said. “If every state adopted a mandate of registration, Medicaid programs would see a reduction in prescribed opioids and save more than $166 million annually in reduced spending on Schedule II opioids.”

A previous study conducted by Dr. Bao and colleagues found that the launch of a drug monitoring program in a state was associated with reduction in Schedule II opioids prescribed to patients seeking pain relief. With access to a comprehensive online database of prescriptions through the drug monitoring programs, physicians are able to make better decisions at the point of care.

“Our findings are of significance because Medicaid enrollees are five to six times as likely to die from an opioid–related overdose as patients who have other insurance,” Dr. Bao said. “States that do not yet have any mandate in place should consider adopting at least mandates of registration.”