Association for Public Policy Analysis & Management

Presented with a prescription painkiller epidemic that claims approximately 16,000 lives annually, states have turned to prescription drug monitoring programs (PDMP) as a tool to halt the abuse of opioid pain relievers (OPR). These online registries track prescriptions written by physicians and filled by patients in order to identify and address inappropriate use. Specifically, PDMPs have the potential to be effective in reducing the practice of “doctor shopping,” whereby individuals obtain OPR prescriptions from multiple doctors and fill them at multiple pharmacies. PDMPs allow a physician or pharmacist to verify a patient’s prescribing history online to identify suspicious activity prior to issuing an OPR prescription. Currently, all but one state have implemented or authorized the creation of prescription drug monitoring programs that track opioid prescribing and dispensing. Despite their rapid diffusion of PDMPs throughout the country, few empirical studies have assessed the impacts of the programs. In order for these programs to be effective in reducing abuse, they require first that doctors access the information included in the PDMP and act upon it. Considering the widespread abuse of OPRs, implementation of a PDMP in a state would be expected to significantly decrease the numbers of prescriptions written for opioid pain relievers by physicians. We test this hypothesis using physician-level data for 2010-2012 from the Centers for Medicare and Medicaid Services that indicates the numbers of OPR prescriptions written for beneficiaries of Medicare Part D. Fourteen states launched online PDMPs during this three-year period, and eight states had yet to implement programs by the end of 2012. Using a difference-in-differences estimation strategy, we compare states with and without PDMPs to examine the effect of program implementation on OPR prescribing rates. We use the same strategy to estimate the effect of PDMPs on prescribing of non-opioid pain relievers to determine if physicians are switching patients to less addictive treatments for pain in response to the policy changes. The results of this study can provide important information about the mechanisms by which monitoring programs do (or do not) succeed in alleviating prescription painkiller abuse.