The Association of State Opioid Misuse Prevention Policies With Patient‐ and Provider‐Related Outcomes: A Scoping Review

Abstract

This scoping review reveals a growing literature on the effects of certain state opioid misuse prevention policies, but persistent gaps in evidence on other prevalent state policies remain. Policymakers interested in reducing the volume and dosage of opioids prescribed and dispensed can consider adopting robust prescription drug monitoring programs with mandatory access provisions and drug supply management policies, such as prior authorization policies for high‐risk prescription opioids. Further research should concentrate on potential unintended consequences of opioid misuse prevention policies, differential policy effects across populations, interventions that have not received sufficient evaluation (eg, Good Samaritan laws, naloxone access laws), and patient‐related outcomes. Context In the midst of an opioid crisis in the United States, an influx of state opioid misuse prevention policies has provided new opportunities to generate evidence of policy effectiveness that can inform policy decisions. We conducted a scoping review to synthesize the available evidence on the effectiveness of US state interventions to improve patient and provider outcomes related to opioid misuse and addiction. Methods We searched six online databases to identify evaluations of state opioid policies. Eligible studies examined legislative and administrative policy interventions that evaluated (a) prescribing and dispensing, (b) patient behavior, or (c) patient health. Findings Seventy‐one articles met our inclusion criteria, including 41 studies published between 2016 and 2018. These articles evaluated nine types of state policies targeting opioid misuse. While prescription drug monitoring programs (PDMPs) have received considerable attention in the literature, far fewer studies addressed other types of state policy. Overall, evidence quality is very low for the majority of policies due to a small number of evaluations. Of interventions that have been the subject of considerable research, promising means of reducing the volume and dosages of opioids prescribed and dispensed include drug supply management policies and robust PDMPs. Due to low study number and quality, evidence is insufficient to draw conclusions regarding interventions targeting patient behavior and health outcomes, including naloxone access laws and Good Samaritan laws. Conclusions Recent research has improved the evidence base on several state interventions targeting opioid misuse. Specifically, moderate evidence suggests that drug supply management policies and robust PDMPs reduce opioid prescribing. Despite the increase in rigorous evaluations, evidence remains limited for the majority of policies, particularly those targeting patient health–related outcomes.

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

“…This study suggests that PDMP mandates may prevent adolescents from beginning down the path of opioid addiction and IDU, which is important to consider alongside evidence that PDMPs could prompt people who are already using opioids to transition to illicit substances [27]. Enactment of PDMP mandates could complement other evidence-based interventions, such as expanded addiction treatment [44,45], naloxone distribution [46,47], safe prescribing interventions [48], and harm reduction services [49].…”

Take-Home Naloxone Programs for Suspected Opioid Overdose in Community Settings: A Scoping Umbrella Review

“…Overdose response after naloxone administration Provision, feasibility and acceptability of naloxone distribution 13 (27.7%) (30,(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48) Effectiveness of naloxone and take-home naloxone (THN) for opioid overdose reversal 10 (21.3%) (10,12,(27)(28)(29)(32)(33)(34)(35)31,36) Overdose response after naloxone administration 6 (12.8%) (51,65,66,72,73,75) Naloxone training and education 6 (12.8%) (12,29,33,36,38,45) Recommendations for policy, practice, and gaps in knowledge 4 (8.5%) (67)(68)(69)(70) Naloxone safety (harm and adverse events related to naloxone administration)…”

Systematic review of the emerging literature on the effectiveness of naloxone access laws in the United States

“…Given that research into other legal and policy interventions, such as prescription drug monitoring programs (PDMPs), has shown that the specific components of these interventions may have differential impacts on opioid‐related public health outcomes [5–8], it is likely that research evaluating the effectiveness of specific NAL components may produce more useful results than studies that evaluate NALs as a binary construct. Furthermore, some NAL components may have a differential impact depending on the environment in which they exist.…”