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. 2018 Jun 5;168(11):783-790.
doi: 10.7326/M17-3074. Epub 2018 May 8.

Association Between Prescription Drug Monitoring Programs and Nonfatal and Fatal Drug Overdoses: A Systematic Review

David S Fink  1 , Julia P Schleimer  1 , Aaron Sarvet  1 , Kiran K Grover  1 , Chris Delcher  2 , Alvaro Castillo-Carniglia  3 , June H Kim  4 , Ariadne E Rivera-Aguirre  3 , Stephen G Henry  3 , Silvia S Martins  1 , Magdalena Cerdá  3
Affiliations

Association Between Prescription Drug Monitoring Programs and Nonfatal and Fatal Drug Overdoses: A Systematic Review

David S Fink et al. Ann Intern Med. .

Abstract

Background: Prescription drug monitoring programs (PDMPs) are a key component of the president's Prescription Drug Abuse Prevention Plan to prevent opioid overdoses in the United States.

Purpose: To examine whether PDMP implementation is associated with changes in nonfatal and fatal overdoses; identify features of programs differentially associated with those outcomes; and investigate any potential unintended consequences of the programs.

Data sources: Eligible publications from MEDLINE, Current Contents Connect (Clarivate Analytics), Science Citation Index (Clarivate Analytics), Social Sciences Citation Index (Clarivate Analytics), and ProQuest Dissertations indexed through 27 December 2017 and additional studies from reference lists.

Study selection: Observational studies (published in English) from U.S. states that examined an association between PDMP implementation and nonfatal or fatal overdoses.

Data extraction: 2 investigators independently extracted data from and rated the risk of bias (ROB) of studies by using established criteria. Consensus determinations involving all investigators were used to grade strength of evidence for each intervention.

Data synthesis: Of 2661 records, 17 articles met the inclusion criteria. These articles examined PDMP implementation only (n = 8), program features only (n = 2), PDMP implementation and program features (n = 5), PDMP implementation with mandated provider review combined with pain clinic laws (n = 1), and PDMP robustness (n = 1). Evidence from 3 studies was insufficient to draw conclusions regarding an association between PDMP implementation and nonfatal overdoses. Low-strength evidence from 10 studies suggested a reduction in fatal overdoses with PDMP implementation. Program features associated with a decrease in overdose deaths included mandatory provider review, provider authorization to access PDMP data, frequency of reports, and monitoring of nonscheduled drugs. Three of 6 studies found an increase in heroin overdoses after PDMP implementation.

Limitation: Few studies, high ROB, and heterogeneous analytic methods and outcome measurement.

Conclusion: Evidence that PDMP implementation either increases or decreases nonfatal or fatal overdoses is largely insufficient, as is evidence regarding positive associations between specific administrative features and successful programs. Some evidence showed unintended consequences. Research is needed to identify a set of "best practices" and complementary initiatives to address these consequences.

Primary funding source: National Institute on Drug Abuse and Bureau of Justice Assistance.

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Conflict of interest statement

Disclosures: Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-3074.

Figures

Figure 1
Figure 1. Evidence search and selection
PDMP = prescription drug monitoring program.
Figure 2
Figure 2. Span of years analyzed in the included studies
See this image and copyright information in PMC

Comment in

References

    1. Guy GP, Jr, Zhang K, Bohm MK, et al. Vital signs: changes in opioid prescribing in the United States, 2006–2015. MMWR Morb Mortal Wkly Rep. 2017;66:697–704. doi: 10.15585/mmwr.mm6626a4. [PMID: 28683056] - DOI - PMC - PubMed
    1. Han B, Compton WM, Jones CM, Cai R. Nonmedical prescription opioid use and use disorders among adults aged 18 through 64 years in the United States, 2003–2013. JAMA. 2015;314:1468–78. doi: 10.1001/jama.2015.11859. [PMID: 26461997] - DOI - PubMed
    1. McCabe SE, West BT, Veliz P, McCabe VV, Stoddard SA, Boyd CJ. Trends in medical and nonmedical use of prescription opioids among US adolescents: 1976–2015. Pediatrics. 2017;139 doi: 10.1542/peds.2016-2387. [PMID: 28320868] - DOI - PMC - PubMed
    1. Patrick SW, Schumacher RE, Benneyworth BD, Krans EE, McAllister JM, Davis MM. Neonatal abstinence syndrome and associated health care expenditures: United States, 2000–2009. JAMA. 2012;307:1934–40. doi: 10.1001/jama.2012.3951. [PMID: 22546608] - DOI - PubMed
    1. Rudd RA, Aleshire N, Zibbell JE, Gladden RM. Increases in drug and opioid overdose deaths—United States, 2000–2014. MMWR Morb Mortal Wkly Rep. 2016;64:1378–82. doi: 10.15585/mmwr.mm6450a3. [PMID: 26720857] - DOI - PubMed

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