Abstract
BackgroundPrescription opioid misuse is an ongoing crisis and a risk factor for injection drug use (IDU). Few studies have evaluated strategies for preventing opioid or IDU initiation among adolescents. We evaluated changes in the proportion of adolescents reporting IDU before and after prescription drug monitoring program (PDMP) mandates were implemented in 18 states compared to 29 states without such mandates.Methods and findingsThis difference-in-differences analysis used biannual Youth Risk Behavioral Surveillance System (YRBSS) data representative of adolescents 17 to 18 years old across 47 states from 1995 to 2017. We compared changes in adolescent IDU in 18 states with and 29 states without PDMP mandates. Among 331,025 adolescents, 51.7% identified as male, 62.1% as non-Hispanic white, 17.4% as non-Hispanic black, and 14.6% as Hispanic. Overall, 3.5% reported IDU during the 2 years prior to PDMP mandates. In the final multivariable difference-in-differences model, we included individual age, sex, and race/ethnicity, as well as state and year as covariates from the YRBSS. We also included state- and year-specific poverty rates based on US Census Bureau data. Additionally, we controlled for state implementation of (non-mandated) PDMPs before states subsequently implemented mandates and pill mill laws. We conducted several sensitivity analyses, including repeating our main analysis using a logistic, rather than linear, model, and with a lead indicator on PDMP mandate implementation, a lag indicator, and alternative policy implementation dates. PDMP mandates were associated with a 1.5 percentage point reduction (95% CI −2.3 to −0.6 percentage points; p = 0.001) in adolescent IDU, on average over the years following mandate implementation, a relative reduction of 42.9% (95% CI −65.7% to −17.1%). The association of PDMP mandates with this reduction persisted at least 4 years beyond implementation. Sensitivity analyses were consistent with the main results. Limitations include the multi-stepped causal pathway from PDMP mandate implementation to changes in IDU and the potential for omitted state-level time-varying confounders.ConclusionsOur analysis indicated that PDMP mandates were associated with a reduction in adolescent IDU, providing empirical evidence that such mandates may prevent adolescents from initiating IDU. Policymakers might consider PDMP mandates as a potential strategy for preventing adolescent IDU.
Highlights
Drug overdose deaths in the US have increased more than 4-fold in under 2 decades
Our analysis indicated that prescription drug monitoring program (PDMP) mandates were associated with a reduction in adolescent injection drug use (IDU), providing empirical evidence that such mandates may prevent adolescents from initiating IDU
We aimed to evaluate whether PDMP mandates were associated with self-reported IDU among adolescents using 1995 to 2017 Youth Risk Behavioral Surveillance Survey (YRBSS) data representative of adolescents in 47 US states
Summary
Drug overdose deaths in the US have increased more than 4-fold in under 2 decades. Of more than 70,237 overdose deaths in 2017, two-thirds involved opioids [1]. Injection drug use (IDU), of opioids, is a major driver of rising overdose mortality. Increasing prevalence of adolescent IDU has coincided with a 3-fold rise in opioid overdose deaths among adolescents since 1999 [3], as well as recent outbreaks of human immunodeficiency virus (HIV) and hepatitis C virus (HCV) among young people [4,5]. IDU is associated with increased risk of overdose [6] and acquisition of HIV, HCV, and other infections [7,8]. Prescription opioid misuse is an ongoing crisis and a risk factor for injection drug use (IDU). We evaluated changes in the proportion of adolescents reporting IDU before and after prescription drug monitoring program (PDMP) mandates were implemented in 18 states compared to 29 states without such mandates
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have