Here is one way to do it: make a hash of arrays of users who have the same score. Sort the keys, print, ta ta.

#!/usr/bin/perl -w

%db = (
   'scores' => {
                'user1' => 200,
                'user2' => 190,
                'user3' => 232,
                'user4' => 187,
                'user5' => 190
               }
);

my %scores;
while (my ($u,$s) = each %{$db{'scores'}}){
    push @{$scores{$s}}, $u;
}
my $i = 1;
for(sort {$b <=> $a} keys %scores){
    local $"=", ";
    print "$i Place: ($_ Points) @{$scores{$_}}\n";
    $i++;
}
__END__
1 Place: (232 Points) user3
2 Place: (200 Points) user1
3 Place: (190 Points) user2, user5
4 Place: (187 Points) user4
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PS: output slightly different