Evidence on whether the implementation of prescription drug monitory programs (PDMP) increases or decreases opioid-related overdoses was found to be “largely insufficient”, according to a new study published in the Annals of Internal Medicine.

Researchers used 5 online databases to extract observational studies from states that examined associations between PDMP implementation and nonfatal or fatal overdoses; 17 articles were identified that met inclusion criteria. All of these studies, however, had methodological shortcomings (ie, inadequate adjustment for time-invariant; time-varying confounding factors; no adjustment for competing laws/policies that may have affected overdoses). “We found that the vast variations in programs and their administrative features make them especially challenging to study,” said Magdalena Cerdá, DrPH, co-senior author of the study.  

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Of the 10 studies which examined the association between PDMP implementation and overdoses, 3 reported a decrease in fatal overdoses after implementation, however, the evidence from these studies was deemed to be low quality. Six of the 10 studies reported no change in overdoses, and 1 reported an increase. Four specific administrative features were found to be associated with a decrease in fatal overdoses (mandatory provider review, provider authorization to access data, more frequent reporting, monitoring of nonscheduled drugs) however, the evidence for this finding was also considered low quality. 

An unintended consequence of PDMPs may be an increase in heroin use as 3 studies showed that heroin overdose deaths increased after program implementation. “This suggested to us that heroin substitution may have increased after PDMP-inspired restrictions on opioid prescribing,” said Silvia Martins, MD, PhD, co-senior author of the study. “We therefore caution that programs aimed at reducing prescription opioids should also address the supply and demand of illicit opioids.”

The authors concluded that “a PDMP’s ability to influence population health probably arises from its unique set of administrative features.” Future research should focus on the development of “empirically based best practices” to replace the variability in current administrative features, as well as focus on initiatives to address the potential consequences. 

For more information visit Annals.org.