Do PDMPs Influence Opioid Drug Overdose Rates?

Sarah T. Melton, PharmD


June 28, 2019

On the heels of the US Department of Health and Human Services (HHS) declaring in 2017 that the opioid crisis is a nationwide public health emergency,[1] HHS released a five-point Opioid Strategy that included strengthening public health data reporting and collection as a top priority.[2] Such reporting and collection includes data from Prescription Drug Monitoring Programs (PDMPs). Effective PDMPs facilitate the statewide collection, analysis, and reporting of information on the prescribing, dispensing, and use of prescription drugs. All US states, with the exception of Missouri, have PDMP legislation in place.[3]

Early PDMPs were primarily established for law enforcement in the regulation of controlled substance prescribing and dispensing practices.These objectives remain important, but most PDMPs today have shifted in focus to enhance patient care and to help develop drug misuse prevention and treatment strategies, especially in the area of opioid medications.[3]

While data on the influence of PDMPs on opioid overdose rates are limited, Fink and colleagues[4] recently examined whether the implementation of PDMPs was associated with any changes in nonfatal and fatal drug overdoses. In a systematic review, the authors identified 17 studies that evaluated implementation, program features, or both, and robustness of various PDMPs.Of 10 studies evaluating the effect that implementation had on fatal drug overdose rates, three showed a decrease, six showed no change, and one actually reported an increase. Of six studies evaluating the association between implementation and heroin-related overdose rates, three reported an increase and three others found a nonsignificant decrease.

This study had its limitations. The quality of evidence was low overall. All studies were observational in nature, and most had inadequate control for confounding factors and no adjustment for competing laws or policies that could affect overdose rates (eg, medical or recreational cannabis laws, Good Samaritan protection, naloxone distribution). Additionally, the identified studies varied in their analysis methods and outcome measurements.

Certain features of PDMPs were shown to be associated with fewer opioid overdose deaths, however.[4] Those that authorize providers to access data, monitor both scheduled and nonscheduled drugs, have frequent data updates, and/or mandate provider review appear to have the best outcomes.

Currently, the evidence is insufficient to conclude whether implementation of PDMPs increases or decreases nonfatal or fatal drug overdoses. An unintended consequence of implementation may be an increase in overdoses linked to illicit opioid use (eg, heroin); therefore, with the implementation of PDMPs, other comprehensive efforts are needed to address the supply of heroin and other illegal drugs, and to engage patients with opioid use disorder in comprehensive treatment. More research is still needed to identify the best practices associated with PDMPs, in addition to community-level initiatives to address the unintended consequences.

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