Measuring Relationships Between Proactive Reporting State-level Prescription Drug Monitoring Programs and County-level Fatal Prescription Opioid Overdoses

Magdalena Cerdá, William R. Ponicki, Nathan Smith, Ariadne Rivera-Aguirre, Corey S. Davis, Brandon D.L. Marshall, David S. Fink, Stephen G. Henry, Alvaro Castillo-Carniglia, Garen J. Wintemute, Andrew Gaidus, Paul J. Gruenewald, Silvia S. Martins

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Abstract

BACKGROUND: Prescription drug monitoring programs (PDMPs) that collect and distribute information on dispensed controlled substances have been adopted by nearly all US states. We know little about program characteristics that modify PDMP impact on prescription opioid (PO) overdose deaths. METHODS: We measured associations between adoption of any PDMP and changes in fatal PO overdoses in 2002-2016 across 3109 counties in 49 states and D.C. We then measured changes related to the adoption of "proactive PDMPs," which report outlying prescribing/dispensing patterns and provide broader access to PDMP data by law enforcement. Comparisons were made within 3 time intervals that broadly represent the evolution of PDMPs (2002-2004, 2005-2009, and 2010-2016). We modeled overdoses using Bayesian space-time models. RESULTS: Adoption of electronic PDMP access was associated with 9% lower rates of fatal PO overdoses after three years (rate ratio [RR] = 0.91, 95% credible interval [CI]: 0.88-0.93) with well-supported effects for methadone (RR = 0.86,95% CI: 0.82-0.90) and other synthetic opioids (RR = 0.82, 95% CI: 0.77-0.86). Compared with states with no/weak PDMPs, proactive PDMPs were associated with fewer deaths attributed to natural/semi-synthetic opioids (2002-2004: RR = 0.72 [0.66-0.78]; 2005-2009: RR = 0.93 [0.90-0.97]; 2010-2016: 0.89 [0.86-0.92]) and methadone (2002-2004: RR = 0.77 [0.69-0.85]; 2010-2016: RR = 0.90 [0.86-0.94]). Unintended effects were observed for synthetic opioids other than methadone (2005-2009: RR = 1.29 [1.21-1.38]; 2010-2016: RR = 1.22 [1.16-1.29]). CONCLUSIONS: State adoption of PDMPs was associated with fewer PO deaths overall while proactive PDMPs alone were associated with fewer deaths related to natural/semisynthetic opioids and methadone, the specific targets of these programs. See video abstract at, http://links.lww.com/EDE/B619.

Original languageEnglish (US)
Pages (from-to)32-42
Number of pages11
JournalEpidemiology (Cambridge, Mass.)
Volume31
Issue number1
DOIs
StatePublished - Jan 1 2020

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Prescription Drugs
Drug Monitoring
Opioid Analgesics
Prescriptions
Methadone
Electronic Prescribing
Controlled Substances
Space Simulation
Law Enforcement

ASJC Scopus subject areas

  • Epidemiology

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Measuring Relationships Between Proactive Reporting State-level Prescription Drug Monitoring Programs and County-level Fatal Prescription Opioid Overdoses. / Cerdá, Magdalena; Ponicki, William R.; Smith, Nathan; Rivera-Aguirre, Ariadne; Davis, Corey S.; Marshall, Brandon D.L.; Fink, David S.; Henry, Stephen G.; Castillo-Carniglia, Alvaro; Wintemute, Garen J.; Gaidus, Andrew; Gruenewald, Paul J.; Martins, Silvia S.

In: Epidemiology (Cambridge, Mass.), Vol. 31, No. 1, 01.01.2020, p. 32-42.

Research output: Contribution to journalArticle

Cerdá, M, Ponicki, WR, Smith, N, Rivera-Aguirre, A, Davis, CS, Marshall, BDL, Fink, DS, Henry, SG, Castillo-Carniglia, A, Wintemute, GJ, Gaidus, A, Gruenewald, PJ & Martins, SS 2020, 'Measuring Relationships Between Proactive Reporting State-level Prescription Drug Monitoring Programs and County-level Fatal Prescription Opioid Overdoses', Epidemiology (Cambridge, Mass.), vol. 31, no. 1, pp. 32-42. https://doi.org/10.1097/EDE.0000000000001123
Cerdá, Magdalena ; Ponicki, William R. ; Smith, Nathan ; Rivera-Aguirre, Ariadne ; Davis, Corey S. ; Marshall, Brandon D.L. ; Fink, David S. ; Henry, Stephen G. ; Castillo-Carniglia, Alvaro ; Wintemute, Garen J. ; Gaidus, Andrew ; Gruenewald, Paul J. ; Martins, Silvia S. / Measuring Relationships Between Proactive Reporting State-level Prescription Drug Monitoring Programs and County-level Fatal Prescription Opioid Overdoses. In: Epidemiology (Cambridge, Mass.). 2020 ; Vol. 31, No. 1. pp. 32-42.
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abstract = "BACKGROUND: Prescription drug monitoring programs (PDMPs) that collect and distribute information on dispensed controlled substances have been adopted by nearly all US states. We know little about program characteristics that modify PDMP impact on prescription opioid (PO) overdose deaths. METHODS: We measured associations between adoption of any PDMP and changes in fatal PO overdoses in 2002-2016 across 3109 counties in 49 states and D.C. We then measured changes related to the adoption of {"}proactive PDMPs,{"} which report outlying prescribing/dispensing patterns and provide broader access to PDMP data by law enforcement. Comparisons were made within 3 time intervals that broadly represent the evolution of PDMPs (2002-2004, 2005-2009, and 2010-2016). We modeled overdoses using Bayesian space-time models. RESULTS: Adoption of electronic PDMP access was associated with 9{\%} lower rates of fatal PO overdoses after three years (rate ratio [RR] = 0.91, 95{\%} credible interval [CI]: 0.88-0.93) with well-supported effects for methadone (RR = 0.86,95{\%} CI: 0.82-0.90) and other synthetic opioids (RR = 0.82, 95{\%} CI: 0.77-0.86). Compared with states with no/weak PDMPs, proactive PDMPs were associated with fewer deaths attributed to natural/semi-synthetic opioids (2002-2004: RR = 0.72 [0.66-0.78]; 2005-2009: RR = 0.93 [0.90-0.97]; 2010-2016: 0.89 [0.86-0.92]) and methadone (2002-2004: RR = 0.77 [0.69-0.85]; 2010-2016: RR = 0.90 [0.86-0.94]). Unintended effects were observed for synthetic opioids other than methadone (2005-2009: RR = 1.29 [1.21-1.38]; 2010-2016: RR = 1.22 [1.16-1.29]). CONCLUSIONS: State adoption of PDMPs was associated with fewer PO deaths overall while proactive PDMPs alone were associated with fewer deaths related to natural/semisynthetic opioids and methadone, the specific targets of these programs. See video abstract at, http://links.lww.com/EDE/B619.",
author = "Magdalena Cerd{\'a} and Ponicki, {William R.} and Nathan Smith and Ariadne Rivera-Aguirre and Davis, {Corey S.} and Marshall, {Brandon D.L.} and Fink, {David S.} and Henry, {Stephen G.} and Alvaro Castillo-Carniglia and Wintemute, {Garen J.} and Andrew Gaidus and Gruenewald, {Paul J.} and Martins, {Silvia S.}",
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T1 - Measuring Relationships Between Proactive Reporting State-level Prescription Drug Monitoring Programs and County-level Fatal Prescription Opioid Overdoses

AU - Cerdá, Magdalena

AU - Ponicki, William R.

AU - Smith, Nathan

AU - Rivera-Aguirre, Ariadne

AU - Davis, Corey S.

AU - Marshall, Brandon D.L.

AU - Fink, David S.

AU - Henry, Stephen G.

AU - Castillo-Carniglia, Alvaro

AU - Wintemute, Garen J.

AU - Gaidus, Andrew

AU - Gruenewald, Paul J.

AU - Martins, Silvia S.

PY - 2020/1/1

Y1 - 2020/1/1

N2 - BACKGROUND: Prescription drug monitoring programs (PDMPs) that collect and distribute information on dispensed controlled substances have been adopted by nearly all US states. We know little about program characteristics that modify PDMP impact on prescription opioid (PO) overdose deaths. METHODS: We measured associations between adoption of any PDMP and changes in fatal PO overdoses in 2002-2016 across 3109 counties in 49 states and D.C. We then measured changes related to the adoption of "proactive PDMPs," which report outlying prescribing/dispensing patterns and provide broader access to PDMP data by law enforcement. Comparisons were made within 3 time intervals that broadly represent the evolution of PDMPs (2002-2004, 2005-2009, and 2010-2016). We modeled overdoses using Bayesian space-time models. RESULTS: Adoption of electronic PDMP access was associated with 9% lower rates of fatal PO overdoses after three years (rate ratio [RR] = 0.91, 95% credible interval [CI]: 0.88-0.93) with well-supported effects for methadone (RR = 0.86,95% CI: 0.82-0.90) and other synthetic opioids (RR = 0.82, 95% CI: 0.77-0.86). Compared with states with no/weak PDMPs, proactive PDMPs were associated with fewer deaths attributed to natural/semi-synthetic opioids (2002-2004: RR = 0.72 [0.66-0.78]; 2005-2009: RR = 0.93 [0.90-0.97]; 2010-2016: 0.89 [0.86-0.92]) and methadone (2002-2004: RR = 0.77 [0.69-0.85]; 2010-2016: RR = 0.90 [0.86-0.94]). Unintended effects were observed for synthetic opioids other than methadone (2005-2009: RR = 1.29 [1.21-1.38]; 2010-2016: RR = 1.22 [1.16-1.29]). CONCLUSIONS: State adoption of PDMPs was associated with fewer PO deaths overall while proactive PDMPs alone were associated with fewer deaths related to natural/semisynthetic opioids and methadone, the specific targets of these programs. See video abstract at, http://links.lww.com/EDE/B619.

AB - BACKGROUND: Prescription drug monitoring programs (PDMPs) that collect and distribute information on dispensed controlled substances have been adopted by nearly all US states. We know little about program characteristics that modify PDMP impact on prescription opioid (PO) overdose deaths. METHODS: We measured associations between adoption of any PDMP and changes in fatal PO overdoses in 2002-2016 across 3109 counties in 49 states and D.C. We then measured changes related to the adoption of "proactive PDMPs," which report outlying prescribing/dispensing patterns and provide broader access to PDMP data by law enforcement. Comparisons were made within 3 time intervals that broadly represent the evolution of PDMPs (2002-2004, 2005-2009, and 2010-2016). We modeled overdoses using Bayesian space-time models. RESULTS: Adoption of electronic PDMP access was associated with 9% lower rates of fatal PO overdoses after three years (rate ratio [RR] = 0.91, 95% credible interval [CI]: 0.88-0.93) with well-supported effects for methadone (RR = 0.86,95% CI: 0.82-0.90) and other synthetic opioids (RR = 0.82, 95% CI: 0.77-0.86). Compared with states with no/weak PDMPs, proactive PDMPs were associated with fewer deaths attributed to natural/semi-synthetic opioids (2002-2004: RR = 0.72 [0.66-0.78]; 2005-2009: RR = 0.93 [0.90-0.97]; 2010-2016: 0.89 [0.86-0.92]) and methadone (2002-2004: RR = 0.77 [0.69-0.85]; 2010-2016: RR = 0.90 [0.86-0.94]). Unintended effects were observed for synthetic opioids other than methadone (2005-2009: RR = 1.29 [1.21-1.38]; 2010-2016: RR = 1.22 [1.16-1.29]). CONCLUSIONS: State adoption of PDMPs was associated with fewer PO deaths overall while proactive PDMPs alone were associated with fewer deaths related to natural/semisynthetic opioids and methadone, the specific targets of these programs. See video abstract at, http://links.lww.com/EDE/B619.

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