Document Type

Thesis or dissertation

Date of this Version

2020

Advisor

Dr. Abby Alpert

Abstract

ABSTRACT

Importance: A number of strategies and policies have been implemented to mitigate the opioid crisis, including state Prescription Drug Monitoring Programs (PDMPs) that are used to track and compile patient prescription data. Because PDMPs are run independently by states, different characteristics of PDMPs can impact success rates of the programs in controlling opioid prescriptions and overdose deaths.

Objective: To assess the association between PDMP operating agency type and opioid prescriptions and opioid overdose death rates.

Research Design: The study utilized time-series data provided by the CDC and KFF, which included information for 49 states and Washington D.C. with effective PDMPs. The impact of state operating type was analyzed using regressions that controlled for the presence of a mandate. A qualitative portion was conducted through an online opt-in survey that was sent out to emergency medicine, pain management, and primary care physicians.

Main Outcome and Measures: The unit of observation was state-years, and the study period was 2006 to 2016 for opioid prescription rate and 2000 to 2017 for opioid overdose death rates.

Results: Using opioid prescription rates, PDMPs with health-facing agencies combined with a mandate decreased prescriptions by approximately 26 prescriptions per 100 individuals, which was statistically significant at the 0.1% level. While most of the specific six agency types also decreased prescription rate, most coefficients were not statistically significant. Looking at opioid overdose death, PDMPs with health-facing agencies showed approximately 6 fewer deaths per 100,000 population, reaching statistically significance at the 0.1% level. Similarly, broken down by specific agency type, most of these coefficients did not reach similar statistically significant. The qualitative survey revealed that the majority of physicians are aware of Pennsylvania’s PDMP operating agency. In addition, these physicians routinely check the PDMP for patient prescription information, and 75.5% of participants have changed their patients’ prescription plan after viewing the PDMP.

Conclusions and Relevance: These findings suggest that operating agency type impacts effectiveness of PDMPs in controlling for prescription rates and opioid overdose deaths. To maximize impact, health-facing agencies should implement and operate PDMPs.

Keywords

opioid, prescription, death, overdose, policy

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Date Posted: 19 May 2020

 

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