Revisiting Paulozzi et al.'s “Prescription Drug Monitoring Programs and Death Rates from Drug Overdose”: Table 1

Abstract

The ecological study by Paulozzi et al. (Online Early: 18 Feb. 2011) raised many critical questions about the use and effectiveness of prescription drug monitoring programs (PDMPs) for a serious public health problem: fatal drug overdose. Despite a rigorous statistical modeling approach, we have two fundamental concerns: the premise and exposure measurement. The premise of this analysis had two important flaws. First, PDMPs were conceived of and have been implemented and funded primarily by mechanisms that are extensions of the criminal justice system. Law enforcement, not public health practitioners or health providers, has been the primary beneficiary of PDMPs since inception, a trend which is only recently beginning to change [1]. Given their current form and common usage, it may be inappropriate to expect PDMPs to have any significant effect on prescription drug overdose mortality. The authors state that PDMPs “employ various interventions … to reduce the abuse and/or diversion of controlled substances” and, by doing so, may alter the rate of overdose death in a state, but they give no examples of states that have used their PDMP effectively in this manner. The most common intervention during the study period of 1999 to 2005 was law enforcement investigation. The authors provide no theory to explain how law enforcement investigation might mitigate drug overdose risk. …