Association for Public Policy Analysis & Management

In response to the ongoing opioid epidemic, nearly every state has adopted a Prescription Drug Monitoring Program (PDMP) designed to reduce opioid abuse by tracking individuals’ allotments of controlled substances. Evidence on the effectiveness of PDMPs in reducing opioid use and improving health outcomes for adults has been mixed. However, there has been no research into the effects of PDMPs on infant health. In-utero exposure to opioids is known to result in negative birth outcomes including neonatal abstinence syndrome, which is associated with low-birth weight and birth defects. Since 1999, the incidence of neonatal abstinence syndrome has increased by more than 300%, while the number of opioids prescribed has quadrupled. In this paper, we provide the first evidence of the impact of state PDMPs on birth outcomes including birth weight, birth defects, and infant mortality.

Using data on the universe of births in the U.S., we first estimate the effect of state PDMP adoption on infant health. We then refine our analyses by exploiting within-state heterogeneity in opioid prescription rates at the county level. This allows us to compare the infant health effects of PDMP adoption in counties with high opioid exposure rates to counties with low opioid exposure rates. Finally, as the features of PDMPs vary widely across states, we explore the sensitivity of our estimates to different PDMP characteristics including those that require provider registration and those that require provider use. Preliminary results suggest that PDMPs requiring provider use reduce the likelihood of a low-birth weight delivery. When combined with laws limiting the scope of pain clinics, we find a reduction in birth defects linked to opioid exposure. Results on infant mortality are still pending.

Our findings provide the first evidence that PDMPs, the most commonly adopted policy to limit opioid abuse, improve infant health. Though all states except Missouri have active PDMPs in place, provider requirements for access and use exhibit a high degree of variability across states. Our work adds to a growing consensus in the literature that PDMPs requiring provider use are more effective at curbing abuse and improving health than those with no provider use requirement.