Mandatory provider review and pain clinic laws reduce the amounts of opioids prescribed and overdose death rates
Open accessAbstract
To address the opioid overdose epidemic in the United States, states have implemented policies to reduce inappropriate opioid prescribing. These policies could affect the coincident heroin overdose epidemic by either driving the substitution of heroin for opioids or reducing simultaneous use of both substances. We used IMS Health's National Prescription Audit and government mortality data to examine the effect of these policies on opioid prescribing and on prescription opioid and heroin overdose death rates in the United States during 2006-13. The analysis revealed that combined implementation of mandated provider review of state-run prescription drug monitoring program data and pain clinic laws reduced opioid amounts prescribed by 8 percent and prescription opioid overdose death rates by 12 percent. We also observed relatively large but statistically insignificant reductions in heroin overdose death rates after implementation of these policies. This combination of policies was effective, but broader approaches to address these coincident epidemics are needed.
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Mandatory provider review of prescription drug monitoring programs before prescribing opioids and laws governing pain clinics reduce the amount of opioids prescribed and prescription overdose death rates.
“Mandatory provider review of prescription drug monitoring programs before prescribing opioids and laws that govern the ownership and operation of pain clinics have been shown to reduce the amount of opioids prescribed and prescription overdose death rates (Dowell et al., 2016).”
From The economic burden of opioid use disorder and fatal opioid overdose in the United States, 2017 (2021) · cites this paper as Dowell et al., 2016
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“, 2016; Kilby, 2015; Meinhofer, 2018) of six studies (Delcher et al., 2016; Dowell et al., 2016; Kilby, 2015; Meinhofer, 2018; Nam, Shea, Shi, & Moran, 2017; Radakrishnan, 2015) that measured that outcome found an increase in heroin poisonings after PDMP implementation.”
BackgroundImpact of New York prescription drug monitoring program, I-STOP, on statewide overdose morbidity
Brown, R. R., Riley, M. R., Ulrich, L., Kraly, E. P., Jenkins, P., Krupa, N. L., & Gadomski, A. (2017) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2017.05.023 · Cited by 51 · see citing works
Spears, C. A., Hodges, S. E., Kiyani, M., Yang, Z., Edwards, R. M., Musick, A., Park, C., Parente, B. A., Lee, H., & Lad, S. P. (2020) · Spine · doi:10.1097/brs.0000000000003572 · Cited by 51 · see citing works
Opioids in Adolescents’ Homes: Prevalence, Caregiver Attitudes, and Risk Reduction Opportunities
Garbutt, J. M., Kulka, K., Dodd, S., Sterkel, R., & Plax, K. (2018) · Academic Pediatrics · doi:10.1016/j.acap.2018.06.012 · Cited by 47 · see citing works
Opioid Abuse And Poisoning: Trends In Inpatient And Emergency Department Discharges
Tedesco, D., Asch, S. M., Curtin, C. M., Hah, J. M., McDonald, K. M., Fantini, M. P., & Hernandez‐Boussard, T. (2017) · Health Affairs · doi:10.1377/hlthaff.2017.0260 · Cited by 46 · see citing works
Prescription drug monitoring program design and function: A qualitative analysis
Rutkow, L., Smith, K. C., Lai, A. Y., Vernick, J. S., Davis, C. S., & Alexander, G. C. (2017) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2017.08.040 · Cited by 46 · see citing works
McGinty, E. E., Bicket, M. C., Seewald, N. J., Stuart, E. A., Alexander, G. C., Barry, C. L., McCourt, A. D., & Rutkow, L. (2022) · Annals of Internal Medicine · doi:10.7326/m21-4363 · Cited by 46 · see citing works
Strengths and weaknesses of existing data sources to support research to address the opioids crisis
Smart, R., Kase, C., Taylor, E. A., Lumsden, S., Smith, S. R., & Stein, B. D. (2019) · Preventive Medicine Reports · doi:10.1016/j.pmedr.2019.101015 · Cited by 45 · see citing works
“…patterns (Table 1) commonly uses prescription information from commercial (Cepeda et al., 2012, 2013a; Cepeda et al., 2013b; Chang et al., 2016; Dowell et al., 2016; Guy et al., 2017; Larochelle et al., 2016; Liu et al., 2013; Qureshi et al., 2015; Rutkow et al., 2015; Schnell and Currie,…”
BackgroundMethodInfluentialHorwitz, J. R., Davis, C. S., McClelland, L., Fordon, R., & Meara, E. R. (2018) · National Bureau of Economic Research · doi:10.3386/w24947 · Cited by 45 · see citing works
Harris, A. B., Marrache, M., Jami, M., Raad, M., Puvanesarajah, V., Hassanzadeh, H. R., Lee, S. H., Skolasky, R. L., Bicket, M. C., & Jain, A. (2019) · The Spine Journal · doi:10.1016/j.spinee.2019.09.011 · Cited by 42 · see citing works
Impact of Spinal Cord Stimulation on Opioid Dose Reduction: A Nationwide Analysis
Adil, S. M., Charalambous, L. T., Spears, C. A., Kiyani, M., Hodges, S. E., Yang, Z., Lee, H., Rahimpour, S., Parente, B. A., Greene, K. A., et al. (2020) · Neurosurgery · doi:10.1093/neuros/nyaa353 · Cited by 43 · see citing works
The Opioid Crisis, Health, Healthcare, and Crime: A Review of Quasi-Experimental Economic Studies
Maclean, J. C., Mallatt, J., Ruhm, C. J., & Simon, K. I. (2022) · The Annals of the American Academy of Political and Social Science · doi:10.1177/00027162221149285 · Cited by 43 · see citing works
“In a related study, Ziedan and Kaestner (2020) estimate a 15 to 50 percent decline in prescription opioid sales after implementation of a PMCL. Dowell et al. (2016) find that PCMLs reduce opioid prescribing and overdoses, with no change in heroin overdoses, when adopted in combination with a mandatory PDMP. Prescribing…”
InfluentialHan, Y., Balkrishnan, R., Hirth, R. A., Hutton, D. W., He, K., Steffick, D., & Saran, R. (2020) · JAMA Network Open · doi:10.1001/jamanetworkopen.2020.16839 · Cited by 39 · see citing works
Macroeconomic Conditions and Opioid Abuse
Hollingsworth, A. J., Ruhm, C. J., & Simon, K. I. (2017) · National Bureau of Economic Research · doi:10.3386/w23192 · Cited by 37 · see citing works
Shackling the Identification Police?
Ruhm, C. J. (2018) · National Bureau of Economic Research · doi:10.3386/w25320 · Cited by 37 · see citing works
Burke, L. G., Zhou, X., Boyle, K. L., Orav, E. J., Bernson, D., Hood, M., Land, T., Bharel, M., & Frakt, A. B. (2020) · Addiction · doi:10.1111/add.14867 · Cited by 35 · see citing works
Shackling the Identification Police?
Ruhm, C. J. (2019) · Southern Economic Journal · doi:10.1002/soej.12333 · Cited by 36 · see citing works
“Page 6 the effects of prescription drug monitoring programs (Dowell et al. 2016; Buchmueller and Carey 2018) and on the effects of other policies, like the legalization of medical marijuana (Chu 2015; Powell, Pacula, and Jacobson 2018; Bradford et al. 2018).”
Implementation and enforcement of state opioid prescribing laws
Stone, E. M., Rutkow, L., Bicket, M. C., Barry, C. L., Alexander, G. C., & McGinty, E. E. (2020) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2020.108107 · Cited by 39 · see citing works
Wen, H., Hockenberry, J. M., & Pollack, H. A. (2018) · JAMA Network Open · doi:10.1001/jamanetworkopen.2018.2943 · Cited by 35 · see citing works
Self-citationGovernment Legislation in Response to the Opioid Epidemic
Jones, M. R., Novitch, M. B., Sarrafpour, S., Ehrhardt, K. P., Scott, B. B., Orhurhu, V., Viswanath, O., Kaye, A. D., Gill, J., & Simopoulos, T. T. (2019) · Current Pain and Headache Reports · doi:10.1007/s11916-019-0781-1 · Cited by 35 · see citing works
Good Samaritan harm reduction policy and drug overdose deaths
Atkins, D. N., Durrance, C. P., & Kim, Y. (2019) · Health Services Research · doi:10.1111/1475-6773.13119 · Cited by 33 · see citing works
“These data were drawn from CDC (2015), Dowell et al (2016), and supplemented with additional state- specific information.18,34 Finally, there is recent evidence that MMLs affect the use and misuse of prescription drugs (and opioids in particular).26-28 We control for MMLs, specifically the presence…”
MethodMedical, Nonmedical, and Illegal Stimulant Use by Sexual Identity and Gender
Philbin, M. M., Greene, E., Martins, S. S., LaBossier, N. J., & Mauro, P. M. (2020) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2020.05.025 · Cited by 34 · see citing works
“, homophobia(34,66) or regulations of physician-prescribing patterns).(2,67,68) Individual-level analyses that also include state-level variables should control for state-level differences in laws relating to sexual minority discrimination (e.”
BackgroundHeins, S. E., Sorbero, M., Jones, C. M., Dick, A. W., & Stein, B. D. (2018) · Substance Use & Misuse · doi:10.1080/10826084.2017.1416407 · Cited by 34 · see citing works
The Hazards of Unwinding the Prescription Opioid Epidemic: Implications for Child Abuse and Neglect
Evans, M. F., Harris, M., & Kessler, L. M. (2020) · American Economic Journal Economic Policy · doi:10.1257/pol.20200301 · Cited by 46 · see citing works
“As a result, must-access PDMPs led to a reduction in prescription opioid misuse, but also a reduction in overall opioid prescriptions (Buchmueller and Carey, 2018; Dowell et al., 2016; Mallatt, 2018).”
BackgroundPrescription Drug Monitoring Programs and Opioid Overdoses
Castillo‐Carniglia, Á., Ponicki, W. R., Gaidus, A. J., Gruenewald, P. J., Marshall, B. D. L., Fink, D. S., Martins, S. S., Rivera‐Aguirre, A., Wintemute, G. J., & Cerdá, M. (2018) · Epidemiology · doi:10.1097/ede.0000000000000950 · Cited by 31 · see citing works
Minimizing Opioid Prescribing in Surgery (MOPiS) Initiative: An Analysis of Implementation Barriers
Coughlin, J. M., Shallcross, M. L., Schäfer, W. L. A., Buckley, B. A., Stulberg, J. J., Ho, K. J., Bilimoria, K. Y., & Johnson, J. K. (2019) · Journal of Surgical Research · doi:10.1016/j.jss.2019.03.006 · Cited by 31 · see citing works
Graetz, I., Yarbrough, C. R., Hu, X. Y., & Howard, D. H. (2020) · JAMA Oncology · doi:10.1001/jamaoncol.2020.0804 · Cited by 31 · see citing works
Buchmueller, T. C., Carey, C. M., & Meille, G. (2020) · Health Economics · doi:10.1002/hec.4020 · Cited by 31 · see citing works
Wei, Y. J., Chen, C., Fillingim, R. B., Schmidt, S. O., & Winterstein, A. G. (2019) · PLoS Medicine · doi:10.1371/journal.pmed.1002941 · Cited by 31 · see citing works
Opioid vs Nonopioid Acute Pain Management in the Emergency Department
Kyriacou, D. N. (2017) · JAMA · doi:10.1001/jama.2017.16725 · Cited by 31 · see citing works
Addressing the Opioid Epidemic: Is There a Role for Physician Education?
Schnell, M. K., & Currie, J. (2017) · National Bureau of Economic Research · doi:10.3386/w23645 · Cited by 31 · see citing works
Changing the Conversation About Opioid Tapering
Dowell, D., & Haegerich, T. M. (2017) · Annals of Internal Medicine · doi:10.7326/m17-1402 · Cited by 29 · see citing works
“Although evidence does not support the hypothesis that initiatives intended to reduce opioid prescribing increase illicit opioid-related overdose at a population level (6), neither this review nor CDC's guideline (2) provides support for involuntary or precipitous tapering.”
Self-citationMcGinty, E. E., Stuart, E. A., Alexander, G. C., Barry, C. L., Bicket, M. C., & Rutkow, L. (2018) · Implementation Science · doi:10.1186/s13012-018-0719-8 · Cited by 31 · see citing works
Stokes, D. C., Purtle, J., Meisel, Z. F., & Agarwal, A. K. (2021) · Journal of General Internal Medicine · doi:10.1007/s11606-021-06678-9 · Cited by 29 · see citing works
Smith, N., Martins, S. S., Kim, J. M., Rivera‐Aguirre, A., Fink, D. S., Castillo‐Carniglia, Á., Henry, S. G., Mooney, S. J., Marshall, B. D. L., Davis, C. S., et al. (2018) · Addiction · doi:10.1111/add.14440 · Cited by 28 · see citing works
Ensuring Patient Protections When Tapering Opioids: Consensus Panel Recommendations
Covington, E. C., Argoff, C. E., Ballantyne, J. C., Cowan, P., Gazelka, H. M., Hooten, W. M., Kertesz, S. G., Manhapra, A., Murphy, J. L., Stanos, S. P., et al. (2020) · Mayo Clinic Proceedings · doi:10.1016/j.mayocp.2020.04.025 · Cited by 28 · see citing works
Griffin, B. A., Schuler, M. S., Stuart, E. A., Patrick, S. W., McNeer, E. A., Smart, R., Powell, D., Stein, B. D., Schell, T. L., & Pacula, R. L. (2021) · BMC Medical Research Methodology · doi:10.1186/s12874-021-01471-y · Cited by 28 · see citing works
Cochran, G., Brown, J. L., Yu, Z., Frede, S. M., Bryan, M. A., Ferguson, A. M., Bayyari, N., Taylor, B., Snyder, M. E., Charron, E. M., et al. (2021) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2021.109067 · Cited by 28 · see citing works
Opioid Prescribing Practices of Orthopaedic Surgeons: Results of a National Survey
Raneses, E., Secrist, E. S., Freedman, K. B., Sohn, D. H., Fleeter, T. B., & Aland, C. M. (2018) · Journal of the American Academy of Orthopaedic Surgeons · doi:10.5435/jaaos-d-16-00750 · Cited by 27 · see citing works
Academic Advocacy: Opportunities to Influence Health and Science Policy Under U.S. Lobbying Law
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- Authors
- Dowell, D., Zhang, K., Noonan, R. K., & Hockenberry, J. M.
- Affiliations
- Centers for Disease Control and Prevention (US)
- National Center for Injury Prevention and Control (US)
- Emory University (US)
- Venue
- Health Affairs
- Publisher
- Health Affairs Publishing, LLC
- Published
- 2016-10
- Volume
- 35
- Issue
- 10
- Pages
- 1876-1883
- ISSN
- 0278-2715 (ISSN-L)
- 1544-5208
- PMC
- PMC6583870
- OpenAlex
- W2528323379
- Cited by
- 264
- References
- 24
- Citations by year
- 2026: 5 · 2025: 11 · 2024: 20 · 2023: 16 · 2022: 19 · 2021: 39 · 2020: 42 · 2019: 44 · 2018: 40 · 2017: 25 · 2016: 2 · 2012: 1
- FWCI
- 36.69
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Health Affairs (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (CC999999)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Keywords
- opioid prescribing, prescription drug monitoring programs, opioid overdose deaths, opioid epidemic, state health policy, prescription review, substance use policy
- MeSH terms
- Analgesics, Opioid, Cause of Death, Humans, Practice Patterns, Physicians', United States, Pain Clinics, Inappropriate Prescribing, Epidemics, Drug Overdose, Prescription Drug Misuse
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