State-level prescription drug monitoring program mandates and adolescent injection drug use in the United States, 1995–2017: A difference-in-differences analysis

Abstract

Background Prescription opioid misuse is an ongoing crisis and a risk factor for injection drug use (IDU). Few studies have evaluated strategies for preventing opioid or IDU initiation among adolescents. We evaluated changes in the proportion of adolescents reporting IDU before and after prescription drug monitoring program (PDMP) mandates were implemented in 18 states compared to 29 states without such mandates. Methods and findings This difference-indifferences analysis used biannual Youth Risk Behavioral Surveillance System (YRBSS) data representative of adolescents 17 to 18 years old across 47 states from 1995 to 2017. We compared changes in adolescent IDU in 18 states with and 29 states without PDMP mandates. Among 331,025 adolescents, 51.7% identified as male, 62.1% as non-Hispanic white, 17.4% as non-Hispanic black, and 14.6% as Hispanic. Overall, 3.5% reported IDU during the 2 years prior to PDMP mandates. In the final multivariable difference-indifferences model, we included individual age, sex, and race/ethnicity, as well as state and year as covariates from the YRBSS. We also included state-and year-specific poverty rates based on US Census Bureau data. Additionally, we controlled for state implementation of (non-mandated) PDMPs before states subsequently implemented mandates and pill mill laws. We conducted several sensitivity analyses, including repeating our main analysis using a logistic, rather than linear, model, and with a lead indicator on PDMP mandate implementation, a lag indicator, and alternative policy implementation dates. PDMP mandates were associated with a 1.5 percentage point reduction (95% CI −2.3 to −0.6 percentage points; p = 0.001) in adolescent IDU, on average over the years following mandate implementation, a relative reduction of 42.9% (95% CI −65.7% to −17.1%). The association PLOS MEDICINE

Mapping the research addressing prescription drug monitoring programs: A scoping review

“…Overall, half of the studies involved patients [9,18,22–24,26,27,32,34,36–38,41–43,45,46,48,50,53,54,59,62,63,65,66,71,73,75,77–80,84–86,88,90,93,95,97,98,100,101,104,105,108–110,115–118,121,123,125,130,131,134,140,144,146,147,149,151,152,154–156,158,159,161,163,165,167] and 47% included health‐care providers [11,19,20,25,29,30,33,35,37,39,40,43,44,49,51,54–61,67–69,71,72,74,76,80–83,87,91,93,94,96,102,103,106,111–114,119,120,122,124,125,127,128,130,132,133,136–139,141,143,145,147,148,150,153,157,160,162,165]. Some studies included both patient and provider populations [36, 37, 54, 59, 80, 93, 130, 147, 166].…”

“…The extracted data from the included studies were then classified into main conceptual categories and summarised to align with the scoping review objective and research questions. The data extraction results are presented in Tables S1 and S2 [18–166], Supporting Information.…”

“…The majority of studies originated from the USA, with only four Canadian studies [11,107,145,158] and one Malaysian study included in this scoping review [21]. The USA overwhelmingly dominate the research on prescription drug monitoring programs with geographical study locations across the country including all states (12%) [50,56,62,78,82,85,92,102,103,105,108,115,116,118,123,142,155,166], Kentucky (7%) [36,37,58,61,64,73,106,135,140,146,164] followed by Florida (6.5%) [43,48,61,76,100,114,134,135,162,164] and Oregon (6%) [9,20,22,38,…”

Prescription drug monitoring programs and prescription pain medication misuse among U.S. high school students—2019

“…To our knowledge, only three studies have examined the impact of PDMPs on opioid-related outcomes among adolescents, and none have focused on prescription pain medication misuse among adolescents. Earlywine, Hadland & Raifman reported that PDMPs with mandated prescriber use significantly reduced injection drug use among 17-18 year olds [10]; Toce et al found significant long-term decreases in opioid poisoning rates among those aged 0-4 years, 5-9 years, and 15-19 years following PDMP implementation [11]; and Theodorou et al reported no statistically significant change in the rate of postoperative opioid prescriptions for California patients aged less than 18 years after a change to the state's PDMP in 2018 [12].…”

Integrated Prescription Drug Monitoring Program for Opioid Prescribing at a Children’s Hospital

“…6 There has been limited research evaluating the use and impact of PDMP on the pediatric population, and knowledge and use of the PDMP by pediatric providers has been limited. [7][8][9] The objective of this study was to evaluate the use of an integrated PDMP into an EHR within a children's hospital, and subsequent opioid prescribing patterns.…”