Evaluating the impact of prescription drug monitoring program implementation: a scoping review

Erin P Finley,Ashley Garcia,Kristen Rosen,Mary Jo Pugh,Jennifer Sharpe Potter,Don Mcgeary

doi:10.1186/s12913-017-2354-5

Abstract

BackgroundPrescription drug monitoring programs (PDMPs) have been implemented in 49 out of 50 states in an effort to reduce opioid-related misuse, abuse, and mortality, yet the literature evaluating the impact of PDMP implementation remains limited. We conducted a scoping review to: (1) describe available evidence regarding impact of PDMPs in the U.S.; and (2) propose a conceptual model to inform future PDMP implementation and evaluation efforts.MethodsScoping systematic review following Arksey and O’Malley’s (2005) methodology. We identified 11 relevant studies based on inclusion criteria using a PubMed database search of English-language studies published 1/1/2000–5/31/16. Data were extracted and thematic analysis conducted to synthesize results.ResultsExtant evidence for the impact of PDMPs as an opioid risk mitigation tool remains mixed. Thematic analysis revealed four domains of opioid-related outcomes frequently examined in original studies evaluating PDMP implementation: (1) opioid prescribing; (2) opioid diversion and supply; (3) opioid misuse; and (4) opioid-related morbidity and mortality. An evaluation framework incorporating these domains is presented that highlights significant gaps in empirical research across each of these domains.ConclusionsEvidence for the impact of state-level PDMPs remains mixed. We propose a conceptual model for evaluating PDMP implementation toward the goals of clarifying PDMP mechanisms of impact, identifying characteristics of PDMPs associated with best outcomes, and maximizing the utility of PDMP policy and implementation to reduce opioid-related public health burden.

Highlights

Prescription drug monitoring programs (PDMPs) have been implemented in 49 out of 50 states in an effort to reduce opioid-related misuse, abuse, and mortality, yet the literature evaluating the impact of PDMP implementation remains limited
The logic of PDMP evaluation studies, consistently presumes that increased monitoring and reporting of opioid prescriptions will be associated with changes in opioid-related outcomes across one or more domains: 1) opioid prescribing behavior, e.g., a reduction in opioid prescribing; 2) opioid diversion and supply; 3) opioid misuse; e.g., doctor shopping; and 4) opioid-related morbidity/mortality, e.g., substance use disorder or overdose
We identified only a single study examining opioid misuse as an outcome of PDMP implementation [15], a concerning gap given the level of national concern about opioid misuse and its potential consequences for leading to abuse and/or overdose

Summary

Introduction

Prescription drug monitoring programs (PDMPs) have been implemented in 49 out of 50 states in an effort to reduce opioid-related misuse, abuse, and mortality, yet the literature evaluating the impact of PDMP implementation remains limited. PDMPs require routine, scheduled reporting by pharmacies of prescription-related data for all medications of interest Such information includes medication data for the past year, date medications were dispensed, and information on patient, prescriber, pharmacy, medicine, and dose. Fulfilling both healthcare and legal functions, PDMPs can be used to generate individual-level reports providing a list of all scheduled

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