Using PDMP Data to Enhance Public Health Surveillance: Opioid and Concurrent Benzodiazepine Use in a State Medicaid...

Accurate opioid dispensing surveillance is critical for guiding public health interventions; however, claims data alone may underestimate opioid utilization and opioid-related quality measures. This study evaluated the impact of linking prescription drug monitoring program (PDMP) data with administrative claims on opioid prescription metrics, Concurrent Use of Opioids and Benzodiazepines (COB) quality measure reporting, and predictors of additional concurrent user identification. Trends in opioid prescription metrics were assessed using 2019-2022 PDMP-linked Mississippi (MS) Medicaid claims. A cohort study of COB measure performance was conducted among Medicaid beneficiaries who filled opioid prescriptions in 2021 without cancer or sickle cell disease. Predictors included sociodemographic, clinical, and prescription-level characteristics. Outcomes included opioid prescription metrics, COB quality measure reporting, and identification of additional concurrent users using PDMP-linked MS Medicaid claims data beyond MS Medicaid data alone. Overall, the proportion of opioid prescriptions paid by Medicaid declined from 68.8% to 58.3% between 2019 and 2022 with corresponding increases in cash and other payer sources. PDMP-linked MS Medicaid claims identified, on average, 12,339 beneficiaries with opioid prescriptions compared with 10,972 using Medicaid claims alone (p <.001). For COB measure reporting, PDMP-linked data identified more concurrent users than Medicaid claims alone (14,067 vs. 9,344), and the COB rate increased from 3.7% to 8.0%, a 4.3-percentage-point increase. Higher average daily opioid dose was associated with additional concurrent user identification, while Black race and concurrent psychotropic medication use were associated with lower odds. Integrating PDMP data with Medicaid claims enhances opioid dispensing surveillance and COB measure accuracy. PERSPECTIVE: This study shows that Medicaid claims alone underestimates opioid dispensing and quality measure estimation compared with PDMP-linked data. Linked data improves COB quality measure detection and surveillance accuracy. These findings underscore the need for policy that facilitate secure PDMP-claims integration to strengthen opioid quality measurement and public health surveillance.