This study examined whether prescription drug monitoring programs (PDMPs) are associated with changes in nonfatal and fatal drug overdoses, identified features of programs differentially associated with those outcomes, and investigated any potential unintended consequences of the programs.
PDMPs are a key component of the president's Prescription Drug Abuse Prevention Plan, which is intended to prevent opioid overdoses in the United States. Data sources were eligible publications from MEDLINE, Current Contents Connect (Clarivate Analytics), Science Citation Index (Clarivate Analytics), Social Sciences Citation Index (Clarivate Analytics), ProQuest Dissertations indexed through December 27, 2017, and additional studies from reference lists. The study focused on observational studies (published in English) from U.S. states that examined an association between PDMP implementation and nonfatal or fatal overdoses. Two investigators independently extracted data from and rated the risk of bias (ROB) of studies by using established criteria. Consensus determinations involving all investigators were used to grade strength of evidence for each intervention. Of 2,661 records, 17 articles met the inclusion criteria. These articles examined PDMP implementation only (n = 8), program features only (n = 2), PDMP implementation and program features (n = 5), PDMP implementation with mandated provider review combined with pain clinic laws (n = 1), and PDMP robustness (n = 1). Evidence from three studies was insufficient to draw conclusions regarding an association between PDMP implementation and nonfatal overdoses. Low-strength evidence from 10 studies suggested a reduction in fatal overdoses with PDMP implementation. Program features associated with a decrease in overdose deaths included mandatory provider review, provider authorization to access PDMP data, frequency of reports, and monitoring of nonscheduled drugs. Three of six studies found an increase in heroin overdoses after PDMP implementation. Evidence that PDMP implementation either increases or decreases nonfatal or fatal overdoses is largely insufficient, as is evidence regarding positive associations between specific administrative features and successful programs. Some evidence showed unintended consequences. Research is needed to identify a set of "best practices" and complementary initiatives to address these consequences. Study limitations noted are the relatively few studies available, high ROB, and heterogeneous analytical methods and outcome measurement. (publisher abstract modified)