Prescription drug monitoring programs: Assessing the association between “best practices” and opioid use in Medicare

Objective: To estimate the impact of implementing prescription drug monitoring program (PDMP) best practices on prescription opioid use. Data Sources: 2007–2012 Medicare claims for noncancer pain patients, and PDMP attributes from the Prescription Drug Abuse Policy System. Study Design: We derived PDMP composite scores using the number of best practices adopted by states (range: 0-14), classifying states as either no PDMP, low strength (0 < score < median), or high strength (score ≥ median). Using generalized linear models, we quantified the association between the PDMP score category and opioid use measures—overall and stratified by disability/age. Sensitivity analyses assessed the general Medicare sample regardless of pain diagnoses, individual PDMP characteristics, and compared GEE model findings to models with state fixed effects. Principal Findings: Compared to non-PDMP states, strong PDMP states had lower opioid cumulative doses (−296 mg; 95% CI: −512, −132), days supplied (−7.84; 95% CI: −10.6, −5.04), prescription fill rates (0.97; 95% CI: 0.95, 0.98), and mean daily doses (−2.31 mg; 95% CI: −3.14, −1.48) but greater prevalence of high opioid doses in disabled adults, whereas there was little or no change in older adults. Findings in states with weak PDMPs were substantively similar to those of strong PDMPs. Results from sensitivity analyses were mostly consistent with main findings except there was a null relationship with mean daily doses and high doses in models with state fixed effects. Conclusions: Comprehensive or minimal adoption of PDMP best practices was associated with mostly comparable effects on Medicare beneficiaries’ opioid use; however, these effects were concentrated among nonelderly disabled adults.