title: Do more robust prescription drug monitoring programs reduce prescription opioid overdose?
abstract: OBJECTIVE
  In the United States, overdose deaths attributed to opioid pain relievers (OPR) have quadrupled since 1999, prompting many states to adopt Prescription Drug Monitoring Programs (PMP). This study aimed to: (1) estimate the relationship of PMP strength with OPR overdose deaths across states and over time; (2) measure what threshold in PMP strength is associated with the greatest reduction in OPR overdose; and (3) assess the relationship of medical marijuana dispensaries with OPR overdose deaths.
  
  
  METHODS
  Panel data from the Centers for Disease Control and Prevention's (CDC's) Wide-ranging Online Data for Epidemiologic Research database (WONDER) were analyzed using fixed effects to regress state-year death rates on an index variable compiled from the Prescription Drug Abuse Policy System (PDAPS) while controlling for PMP administration, demographic factors and laws that might affect OPR overdose.
  
  
  METHODS
  Age-adjusted opioid overdose death rates for all 50 states and the District of Columbia between 1999 and 2014 for a total of 816 observations.
  
  
  METHODS
  PMP strength was calculated using legal data compiled by the Prescription Drug Abuse Policy System (PDAPS). In addition to demographic controls, other covariates included laws that regulate pain clinics, access to naloxone, use of emergency services (Good Samaritan Laws) and medical marijuana.
  
  
  RESULTS
  PMP strength was associated negatively with OPR overdose deaths. Every 1-point increase in PMP strength was associated with a 1% [95% confidence interval (CI) = 0.2-2%] reduction in overdose deaths. When collapsed into quartiles, PMPs in the third quartile were associated with an approximately 18% (95% CI = 1.6-29%) reduction in OPR overdose death rates compared with states without a PMP. States with medical marijuana dispensaries reported a 16% (95% CI = 1-30%) reduction in OPR overdoses.
  
  
  CONCLUSIONS
  US states that have more robust prescription drug monitoring programs have fewer prescription opioid overdose deaths than states with weaker PMPs. States with medical marijuana dispensaries also report fewer opioid overdose deaths than states without these.
authors.affiliation: School of Public Policy, University of Maryland, College Park, MD, USA.
authors.forename: Bryce
authors.initials: B
authors.lastname: Pardo
mesh_terms: D062787:Drug Overdose / Q000517:prevention & control*; D006801:Humans; D009293:Opioid-Related Disorders / Q000517:prevention & control*; D063487:Prescription Drug Misuse / Q000517:prevention & control*; D000073958:Prescription Drug Monitoring Programs / Q000706:statistics & numerical data*; D014481:United States
keywords: Law/regulation; medical marijuana; opioids; overdose; prescription drug monitoring programs; prescription drugs