Research Update: State prescription drug monitoring programs and drug overdose deaths

The United States is experiencing an epidemic of drug overdoses. Over 27,000 people died from overdoses in 2007, a number that has risen five-fold since 1990 and has never been higher. The increase has been driven by overdoses of prescription drugs. Prescription drugs now contribute to more unintentional overdose deaths than heroin and cocaine combined.

To address this issue, many states have created prescription drug monitoring programs (PDMP), which use databases to track prescriptions of controlled substances. PDMPs are designed to prevent the misuse of prescription drugs that are prone to abuse—such as opioid painkillers and sedatives like benzodiazepines—by making doctors aware of the prescription histories of their patients. Thirty-five states now have operational PDMPs. These range from programs with limited staffing and outreach ability to programs with large, well-staffed programs that make extensive use of the data they collect.

Two recent CDC studies suggest that the state-specific differences among PDMPs might influence whether or not they are effective in reducing opioid misuse and overdose.

Comparing states with and without PDMPs

This national study looked at opioid prescribing and opioid-overdose death rates of states with and without PDMPs from 1999 to 2005. The researchers made the following key observations:

• The presence of a PDMP alone is not enough to reduce overdose rates or opioid use. PDMP states and non-PDMP states experienced the same increase in opioid-related overdose rates.
• The three largest states with PDMPs had lower rates of opioid prescribing and overdose than other PDMP states. California, New York, and Texas, all of which have PDMPs, had lower rates of opioid prescribing and overdose than other PDMP states, but the information collected in this study did not explain why.
• PDMPs can change the way physicians prescribe. The presence of a PDMP was associated with a shift toward the prescribing of hydrocodone, an opioid that may be less scrutinized than other opioids such as oxycodone or methadone.

Comparing the effectiveness of two state PDMPs

This study used 2006 data to compare the overdose death and opioid use rates of Pennsylvania and New York. Both states had long-established PDMPs, but with important differences. New York’s PDMP monitored all controlled substance prescriptions, while Pennsylvania’s only tracked drugs thought to be more prone to abuse. Also, New York’s PDMP regularly monitored prescription records for signs of illegal activity, while Pennsylvania did not monitor its prescriptions until very recently. The researchers made the following key observations:

• Pennsylvania had substantially higher opioid use and overdose rates than New York. Drug-overdose death rates were 60% higher in Pennsylvania than in New York, and opioid usage was 50% higher in Pennsylvania.
• The different rates may be attributable to policy differences between the states. The researchers pointed to differences in how each state monitored and regulated opioids as a possible explanation for the varying rates. For example, New York has staff throughout the state who follow up on irregularities in prescribing.

Implications for Prevention

These studies confirm that PDMPs are not a magic bullet for ending the prescription drug overdose epidemic. Having lower overdose rates may depend on both a PDMP and other interventions. Additional studies are needed to identify what the other components of effective policies are. Further, PDMPs may impact this epidemic in other ways that have not been studied. For instance, PDMPs may reduce doctor shopping or deter prescription drug diversion. The choices states make in how they operate their PDMPs need to be rigorously evaluated, as these decisions may affect the programs’ effectiveness.