Prescription Drug Monitoring Programs and Opioid Overdose Deaths: Variations in Policy Impact By Type of Program, Type of Opioid, and Local Access to Medication Assisted Treatment

Introduction: Prescription drug monitoring programs (PDMPs), state-level databases that collect information on dispensed controlled substances, have been adopted by every US state. Little information exists on the types of PDMP models that have the greatest impact on opioid overdoses, or the unintended consequences that may arise if access to prescription opioids is limited without complementary investment in opioid dependence treatment. In this study, we examined the combinations of PDMP features that were associated with the greatest change in opioid overdoses, overall and by type of opioid. Second, we tested whether the relationship between types of PDMP models and opioid overdoses varied by county-level access to medication assisted treatment.

Methods: We examined how transitions between types of PDMP models (estimated through latent transition analysis) contributed to changes in fatal opioid overdose in 3,109 counties in 49 states from 2002 to 2016. We conducted a time-series study, comparing rates of opioid overdose deaths in counties within states that implemented PDMPs, before versus after PDMP changes were implemented. Geocoded data on SAMHSA behavioral treatment services, programs providing methadone for the treatment of opioid addiction, and physicians/treatment programs providing buprenorphine for opioid addiction were used to measure county-level access to medication assisted treatment.

Results: Online PDMP access was associated with 9% lower rates of fatal PO overdoses after three years (rate ratio (RR) = 0.91 (95% credible interval (CI): 0.88, 0.93) and a 22% increase in heroin overdoses (RR=1.22; 95% CI: 1.16, 1.29). States that permitted/required proactive reporting of outlying patterns to law enforcement, licensing bodies and prescribers/dispensers, and provided access to PDMP data to law enforcement without requiring a subpoena, warrant, or active investigation had up to 14% (RR = 0.86; 95% CI: 0.80, 0.91) lower fatal prescription opioid overdose rates and up to 6% (RR = 0.94; 95% CI: 0.90, 0.98) lower heroin overdose rates than states with no/weak PDMP. The association between PDMP enactment, county-level access to medication assisted treatment, and opioid overdoses will also be presented at the symposium.

Conclusions: Our study suggests that proactive PDMPs, that permit or require proactive reporting of outlying prescribing and dispensing patterns to PDMP users, are associated with the greatest reductions in prescription opioid and heroin overdose deaths. At the same time, investment in a full continuum of evidence-based programs, such as expanded access to pharmaceutical and behavioral treatments for opioid use disorder, is needed to avoid potential unintended consequences of PDMPs among individuals dependent on opioids.