Research on Prescription Drug Monitoring Programs (PDMPs)

"Research on the effects of PDMPs on fatal overdoses has yielded mixed results. Some studies have found a decrease in overdose deaths related to prescription opioids after PDMPs were implemented.5-7 In contrast, another study reported a significant rise in total drug overdose rates,8 and other studies have found no meaningful link between PDMPs and prescription opioid-related overdose deaths.9, 10 Some evidence suggests that “must-query” PDMPs, which mandate that prescribers check the database before prescribing certain controlled substances, are most effective in lowering prescribing rates.11-13 However, research examining the impact of “must-query” PDMPs on overdose have also yielded inconsistent findings. Some evidence suggests that must-query PDMPs contributed to a reduction in prescription opioid deaths,11, 14, 15 as well as increased rates of overdose death related to heroin and cocaine.14 Other studies have reported increases in opioid-related overdoses following adoption of must-query PDMPs,16-19 and some found no change in the number of opioid-related deaths.20 Another important source of discrepancy in findings across studies examining the association between PDMP implementation and overdose rates is the timing of the studies. Earlier studies, conducted when prescription opioids were the primary driver of overdose deaths, may yield different conclusions than those conducted in later years marked by the rise of heroin and fentanyl. This temporal shift in the specific opioids involved, as well as in the populations most affected, hinders the inability to make direct comparisons.

"Most studies to date focus on overall population rates with no consideration for heterogeneity across racial and ethnic groups. One study found that PDMPs with must-query requirements were associated with a greater reduction in opioid dispensing in Black patients than in White patients, even though Black patients nationally already had lower rates of nonmedical prescription opioid use and overdose.21 Absent from the literature is the examination of the impact of PDMPs on fatal overdose rates by race and ethnicity. Racial and ethnic disparities in opioid overdose mortality are rising: nationally, drug overdose death rates recently increased among Black, Hispanic, and Indigenous populations even as rates among White individuals declined, and Black communities experienced a 49% jump during the COVID-19 surge alone.22 In particular, natural and semisynthetic opioid mortality has continued climbing among Black American individuals at an average of 17% per year from 2013 to 2020, whereas rates among White individuals plateaued. Given that the rates of fatal overdose caused by natural semisynthetic opioids are rising among non-White populations, it is critical to understand the impact that PDMPs have among these populations. Without this evidence, we risk perpetuating policies that fail to address, or even exacerbate, racial disparities in opioid-related harm. It is important to understand the influence of PDMPs across racial and ethnic groups not only because of observed differences in opioid use patterns but also because of long-standing inequities in health care access, pain management, and substance use treatment. Policies like PDMPs are not implemented in a vacuum; they intersect with existing structures and biases across multiple levels such as other policies, clinical recommendations, and long-standing structural racism. Despite the widespread adoption of PDMPs, little is known regarding whether these policies, particularly must-query provisions, mitigate or exacerbate such disparities."