Background
Method
Step 1. Identify research goal(s) | 1) Describe available evidence regarding impact of PDMPs in the United States; 2) Propose a conceptual model for PDMP evaluation to inform future implementation and evaluation efforts. |
Step 2. Identify relevant studies | PubMed database search of English-language studies published between 1/1/2000–08/18/2015 using key words “Prescription drug monitoring program” and “Opioid prescription monitoring program”. Inclusion criteria: human; English language; original research; peer-reviewed; direct assessment of outcomes related to impact or effectiveness of PDMP implementation. Additional studies were identified using reference lists of relevant articles. Prior to submission, this search was updated to include articles from 8/19/2015–5/31/16. |
Step 3. Study selection | Irrelevant and duplicate articles were identified by two reviewers at the abstract and title level. Systematic reviews, commentaries, and non-U.S. studies were excluded. Full text of original studies remaining was examined by two reviewers. A third reviewer provided input as needed to achieve consensus. |
Step 4. Charting the data | A data chart collection form was developed to facilitate extraction of findings and key contextual factors from each study. Consistent with scoping methodology, this sheet was updated collectively and iteratively as familiarity with literature increased. Two reviewers independently assessed articles, then met to determine compatibility in approaches. A third reviewer provided input when needed to achieve consensus. |
Step 5: Collating, summarizing, and reporting results | The authorship team then independently and collaboratively reviewed summative findings of the data extract, resulting in: identification of distinct domains of opioid-related outcomes hypothesized to be associated with PDMP implementation; conceptualization of an evaluation framework; and synthesis of current PDMP research findings, including recognition of research gaps. |
Search strategy
Data synthesis and analysis
Results
Thematic analysis
Research findings
Article | State(s)/Years Examined | Outcome measure | Design/Methods | Findings | Evidence for PDMP Benefit |
---|---|---|---|---|---|
Domain 1: Opioid Prescribing Behavior | |||||
Paulozzi, 2011a [3] | PDMP and non-PDMP states; 1995–2005 | Mean MME rates | Crude mean MMEb rates and their standard errors for PDMP and non-PDMP states were calculated by year and across 1999–2005 timespan. | According to results of a regression analysis, the presence of a PDMP was not a significant predictor of MME rates. | No |
Brady, 2014 [2] | PDMP and non-PDMP states; 1999–2008 | Opioids dispensed per quarter for each state from 1999 to 2008 | Multivariable linear regression model with generalized estimating equations assessed the effect of state PDMPs on per-capita dispensing of MMEs. | Overall, implementation of state PDMPs up to 2008 did not show significant impact on per-capita opioids dispensed. Examined state-by-state, authors found PDMP implementation associated with per capita MME decline in 9 states, increase in 8 states, and no effect in 14 states. | No |
Rasubala, 2015 [21] | New York; 2012–2014 | Frequency and volume of opioid prescriptions by dentists in a dental urgent care center | Cross-sectional survey of a dental urgent care center 3 months before and 6 months after implementation of a PDMP | Total prescribed opioids decreased 78% by dentists in a dental urgent care center after a mandatory PDMP was implemented. | Yes |
Ringwalt, 2015 [11] | North Carolina; 2009–2011 | Number of filled prescriptions for opioids | Examined associations between total number of providers who used the PDMP, mean number of days providers queried the system, and filled opioid prescriptions. | Strong positive association between increasing use of PDMP and opioid analgesic prescriptions over time. | No |
Rutkow, 2015 [25] | Florida; 2010–2012 | Opioid volume, per transaction, MME prescribed, MME per transaction, days’ supply per transaction, prescriptions dispensed. | Comparative interrupted time-series analysis to assess the effect of PDMP and ‘pill mill law’ implementation on a closed cohort of prescribers, retail pharmacies, and patients. | Jointly the PDMP and ‘pill mill’ policies were associated with reductions in total opioid volume, mean MME per transaction, and total number of opioid prescriptions dispensed. | Yes |
Domain 2: Opioid Diversion and Supply | |||||
Reisman, 2009a [12] | PDMP and non-PDMP states; 1997–2003 | State prescription opioid shipments (ARCOS)b
| Compared state prescription opioid shipments in 14 states with PDMPs (intervention group) and 36 states without PDMPs (control group). | States with PDMPs received fewer oxycodone shipments that non-PDMP states; opioid shipments in all states continued to rise. | Yes |
Surratt, 2014 [26] | Florida; 2009–2012 | Quarterly prescription opioid diversion rates | Changes in prescription opioid diversion rates identified using quarterly law enforcement data after implementation of PDMP and ‘pill mill’ laws assessed using hierarchical linear models. | Significant decline in oxycodone diversion; nonsignificant (p = 0.08) decline in hydrocodone diversion; no decline in fentanyl, hydromorphone, or tramadol. | Yes |
Domain 3: Opioid Misuse | |||||
Reifler, 2012a [15] | PDMP and non-PDMP states; 2003–2009 | Cases of intentional exposure to opioids (RADARS)b
| Repeated measures negative binomial regression was applied to quarterly case data to estimate opioid misuse trends. PMP presence was modeled as a time-varying covariate for each state. | Results suggest PDMPs are associated with a mitigation of increasing opioid misuse over time in both the general population as well as within the population seeking treatment at Opioid Treatment Programs. | Yes |
Domain 4: Opioid-related Morbidity/Mortality | |||||
Reisman, 2009a [12] | PDMP vs. non-PDMP states; 1997–2003 | Inpatient prescription opioid treatment admissions per year | Inpatient admissions for prescription opioid abuse (TEDS)b in 14 states with PDMPs (intervention group) and 36 states without PDMPs (control group). | PDMP states reported a smaller increase in opioid treatment admissions per year (p[=0.06). Patients receiving inpatient drug treatment in PDMP states were less likely to have been admitted for prescription opioids. | Yes |
Paulozzi, 2011a [3] | PDMP and non-PDMP states; 1999–2005 | Rates of drug overdose and opioid-related mortality by state | Regression analysis using mortality data by state and year, crude mean mortality and standard error for PDMP and non-PDMP states. | Mortality rates did not differ by a statistically significant margin between PDMP and non-PDMP states. | No |
Reifler, 2012a [15] | PDMP and non-PDMP states; 2003–2009 | Opioid treatment admissions | Repeated measures negative binomial regression applied to quarterly surveillance data from 2003 to mid-2009 to estimate opioid abuse trends. PDMP presence was modeled as a time-varying covariate for each state. | States with PDMPs appeared to experience smaller increases in drug abuse over time. | Yes |
Li, 2014 [16] | PDMP and non-PDMP states; 1999–2008 | Drug overdose mortality data for state-quarters | Multivariate negative binomial regression modeling examined drug overdose mortality for states with and without PDMPs during 1999–2008. | PDMP states experienced higher drug overdose mortality overall; PDMP impact on mortality varied by state. | No |
Delcher, 2015 [17] | Florida; 2003–2012 | Monthly counts of oxycodone-caused deaths | Time-series, quasi-experimental research design with ARIMAb statistical models examined monthly counts of oxycodone-caused deaths using a binary variable (pre/post-implementation). | Implementation of Florida’s Prescription Drug Monitoring Program was associated with a significant decline in oxycodone-caused mortality | Yes |
Maughan, 2015 [27] | 11 Multi-state metropolitan areas; 2004–2011 | Rates of emergency department visits involving opioid analgesics | Using retrospective data (DAWN)b, generalized estimating equations assessed PDMP implementation and opioid-related morbidity. | PDMP implementation was not associated with change in rates of ED visits involving opioid analgesics. | No |