Where Does It Hurt? The Impact of Prescription Drug Monitoring Programs on Pain Management in Home Health Care

Abstract

As states pass regulations to curb opioid abuse, what are the consequences for legitimate pain management? Forty-nine states have adopted prescription drug monitoring programs (PDMP) to detect potentially inappropriate opioid prescribing and use. Several studies have estimated the impact of PDMPs in reducing abuse and deaths. However, no study addresses an equally important question — do PDMPs generate negative or positive spillover effects for pain management in the millions of Americans suffering from pain? We use 2003-2013 home health agency-level panel data to assess the effect of PDMPs on pain improvements in home health patients. We hypothesize that implementation of a PDMP in the context of home health care may induce agencies to substitute away from opioids to other (potentially more effective) treatments, such as physical therapy. Using a fixed effects, two-stage least squares model, we estimate pain improvements as a result of whether a state has implemented a PDMP and control for endogeneity between state policies and pain management practices. We find that home health agencies in states with PDMPs are on average more successful at improving pain in their patients. However, the effect varies according to how the agencies are reimbursed for services. Our results suggest that home health agencies are adapting their models of care to state opioid policies, and the incentives embedded in reimbursement systems can either promote better or worse pain management.