Prescription Drug Monitoring Programs Are Not Associated with Lower Rates of Overdose or Prescription Opioid Consumption

Electronic prescription drug monitoring programs (PDMPs) proliferated from 16 to 32 states in the 2000s in an effort to address overdose fatalities attributed to increased prescriptions for opioid analgesics. Researchers conducted time-series regression analyses of 1999–2005 PDMP data to determine state-level associations between PDMPs, overdose rates, and prescription opioid distribution rates. Results were adjusted for median age, race/ethnicity, education, and level of urbanization.

• Over the study period, mean drug overdose rates doubled, opioid-related overdose mortality rates tripled, and mean morphine milligram equivalent (MME) consumption rates tripled with no significant differences between states with or without PMDPs.

• States with PDMPs had rates of Schedule-III opioid consumption (mainly hydrocodone) that were 20-MME-per-person higher, and rates of Schedule-II opioid consumption that were 20-MME-per-person lower, than states without PDMPs.

• The 3 PDMP states with serialized tamper-resistant prescription forms and the largest populations (California, New York, and Texas) had lower drug overdose mortality, lower opioid-related overdose mortality, and lower rates of opioid prescribing than other PDMP and non-PDMP states.

• Presence of a PDMP was not a significant predictor of drug overdose mortality, opioid-related overdose mortality, or MME consumption.

Comments:

According to these results, PDMPs are not associated with a reduction in overdose or opioid prescription rates. Their presence was associated with the prescription of opioids that are less regulated. The study did not account for the possibility that PDMPs were implemented in states with higher overdose rates or that implementation of PMDPs may increase overdose surveillance. The requirement of serialized tamper-resistant prescription forms may reduce overdose but should be balanced with the potential concomitant decrease in access to treatment. To be an effective tool for addressing the rise in prescription-drug-related overdose, PMDPs require further development.

Alexander Y. Walley, MD, MSc

Reference:

Paulozzi LJ, Kilbourne EM, Desai HA. Prescription drug monitoring program and death rates from drug overdose. Pain Med. 2011;12(5):747–754.