Does Requiring Prescribers to Check Prescription Drug Monitoring Programs Increase Opioid-related Deaths?

Prescription drug monitoring programs (PDMPs) track controlled substance prescriptions, and they have been shown to reduce opioid prescribing when providers are required to access them program prior to prescribing opioids. To study whether the use of PDMPs is associated with prescription opioid or heroin-related deaths, researchers used Multiple Correspondence Analysis, a novel modeling tool, to create a single continuous measure of PDMP regulatory strength from multiple separate PDMP features.

  • No association was found between PDMP regulatory strength and prescription opioid or heroin-related deaths.
  • When the continuous measure of PDMP regulatory strength was replaced with a single dichotomous variable defining the requirement that prescribers access the PDMP prior to prescribing, a positive association was found between that requirement and both prescription opioid and heroin-related death rates.

Comments: PDMPs have been promoted as important tools for identifying individuals who attempt to obtain prescription opioids from multiple providers or pharmacies. This study provides mixed evidence that the regulatory strength of PDMPs is associated with increased opioid-related overdose deaths. While the requirement that providers access the PDMP prior to prescribing opioids may be particularly salient, the difficulty of asserting causal inference in such observational studies is significant.

Joseph Merrill, MD, MPH

Reference: Meadowcroft D, Whitacre B. Do prescription drug monitoring programs encourage prescription—or illicit—opioid abuse? Subst Abus. 2019 [Epub ahead of print]. doi: 10.1080/08897077.2019.1695707.

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