Impact of New York prescription drug monitoring program, I-STOP, on statewide overdose morbidity

Association Between Prescription Drug Monitoring Programs and Nonfatal and Fatal Drug Overdoses

“…Of these studies, 8 examined PDMP implementation in general (21, 29, 30–35), 2 looked at program features alone (23, 24), 5 analyzed both PDMP implementation and program features (19, 20, 22, 27, 28), 1 investigated PDMP implementation with mandated provider review combined with pain clinic laws (25), and 1 assessed PDMP robustness (26). The study that examined robustness generated a score of PDMP administrative strength or “robustness” by assigning weights to specific administrative features on the basis of extant evidence, or expert judgment if evidence was lacking, regarding the expected effect of the characteristic on prescribing or overdose, then summing the weights for a PDMP in a given state for a particular year (26).…”

“…The study that examined robustness generated a score of PDMP administrative strength or “robustness” by assigning weights to specific administrative features on the basis of extant evidence, or expert judgment if evidence was lacking, regarding the expected effect of the characteristic on prescribing or overdose, then summing the weights for a PDMP in a given state for a particular year (26). Among the 7 studies that examined program features, whether alone (22, 24) or in addition to PDMPs in general (19, 20, 22, 27, 28), mandatory provider use of or registration for the PDMP was the most frequently evaluated administrative feature, with 1 study examining the association with nonfatal overdoses (28), 4 studies investigating the association with fatal overdoses (20, 22, 24, 27), and 1 study looking at the association with both nonfatal and fatal overdoses (23). In addition, 2 studies examined state authorization for providers to access PDMP data (20, 22), 2 focused on proactive reporting of PDMP data to providers (19, 28), 1 looked at interstate sharing of PDMP data (19), 3 investigated the frequency of reports (19, 27, 28), 1 examined PDMP housing agency (19), and 3 analyzed the monitoring of nonscheduled drugs (19, 27, 28).…”

“…Two studies used state-level data: 1 used information from the Florida Medical Examiners Commission regarding oxycodone-involved deaths (29); the other used data from New York health care facilities on inpatient and emergency department visits (23). National data on nonfatal overdoses came from either the Drug Abuse Warning Network (30, 31) or Truven Health MarketScan administrative claims (28), whereas information on fatal drug overdoses was obtained from the Multiple Cause of Death files produced by the National Center for Health Statistics of the Centers for Disease Control and Prevention.…”

“…Nine studies (1 low, 3 moderate, 3 serious, and 2 critical ROB) investigated the relationship between specific PDMP administrative features and nonfatal (23, 28) or fatal (19, 20, 22–27) overdoses. The studies found reduced rates of fatal overdose in states with programs that shared data with other states (19), had mandatory provider review (20, 28), monitored noncontrolled substances (19, 27, 28), proactively reported patients' controlled substance prescription history to in-state prescribers and licensure boards (herein called proactive reporting) (28), and updated data at least weekly (27, 28).…”

“…One of these studies found no change in the number of opioid-related deaths (27), and 2 reported an association between mandated provider review and reduced rates of fatal overdose related to prescription opioids (20, 22) and benzodiazepines (22), as well as increased rates of overdose death related to heroin and cocaine (22). The other 3 studies, which did not include state fixed effects to adjust for time-fixed sources of confounding, reported statistically significant increases in opioid-related overdoses (23, 24, 28). …”