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State health officials report declines in prescribing but warn Arkansas still exceeds national opioid prescribing rates
Summary
Arkansas Department of Health officials told the Public Health, Welfare and Labor Committee that doctor-shopping has dropped about 80% and opioid pill counts have fallen since 2016, but the state still prescribes opioids at roughly twice the national average; PDMP enhancements and prescriber audits were discussed.
State health officials presented the Arkansas Prescription Drug Monitoring Program annual report and highlighted multiple encouraging trends while urging continued vigilance.
At a committee meeting, Dr. Rick Smith, medical director for the PDMP, said doctor-shopping has fallen by about 80% and the total number of opioid pills dispensed has decreased about 21% since 2016. He told lawmakers the state has seen a roughly 12% decline in opioid prescriptions over the past four years and that morphine milligram equivalents (MME) dispensed in Arkansas fell about 28% between 2014 and 2018. Dr. Smith cautioned, however, that Arkansas remains roughly twice the national average in the number of prescriptions written per capita.
Hailey Ortiz, PDMP branch chief, described efforts to make prescriber-comparison reports a useful educational tool. The PDMP is issuing quarterly prescriber comparison reports to physicians, APRNs and PAs; the department recently produced a list of prescribers who ranked in the top percentiles across multiple metrics used by the medical board. Ortiz said the medical board requested seven metrics (two double-weighted), including average daily MME per prescription, total MME prescribed, overlapping opioid and benzodiazepine prescriptions, day-supply totals and counts of high-strength oxycodone and hydromorphone prescriptions.
Committee members pressed the presenters on limitations of the PDMP data. Dr. Smith said county maps in the report reflect patients' addresses rather than prescribers' locations and noted cross-border prescribing and pharmacy fills complicate interpretations for border counties. He told Representative Boyd the PDMP can analyze prescriptions filled in Arkansas that were written by out-of-state prescribers but that automatic interstate sharing is limited by other states’ laws and systems.
Lawmakers asked whether audits detect prescribers who check the PDMP before prescribing. Ortiz said the PDMP can verify that prescribers have an account but cannot yet run an automated audit to confirm whether the prescriber viewed PDMP data prior to issuing a prescription; that capability is under development. Ortiz said manual audits and board enforcement actions have improved registration rates and that licensing boards have held providers accountable when accounts were missing.
The presenters also discussed gaps in data integration—such as limited reporting by certain VA facilities and the lack of methadone clinic reporting under current federal rules—and said proposed federal rule changes could make some clinic-dispensed medications reportable to state PDMPs in the future.
The department said it will continue working with licensing boards, the PDMP vendor and partner states to refine metrics, expand useful audits and improve the value of reports used for education and enforcement. No formal policy vote was taken on PDMP changes during the hearing.
