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Prescription Drug Monitoring Programs and Opioid Overdoses: Exploring Sources of Heterogeneity.
Epidemiology. 2019 03; 30(2):212-220.E

Abstract

BACKGROUND

Prescription drug monitoring program are designed to reduce harms from prescription opioids; however, little is known about what populations benefit the most from these programs. We investigated how the relation between implementation of online prescription drug monitoring programs and rates of hospitalizations related to prescription opioids and heroin overdose changed over time, and varied across county levels of poverty and unemployment, and levels of medical access to opioids.

METHODS

Ecologic county-level, spatiotemporal study, including 990 counties within 16 states, in 2001-2014. We modeled overdose counts using Bayesian hierarchical Poisson models. We defined medical access to opioids as the county-level rate of hospital discharges for noncancer pain conditions.

RESULTS

In 2010-2014, online prescription drug monitoring programs were associated with lower rates of prescription opioid-related hospitalizations (rate ratio 2014 = 0.74; 95% credible interval = 0.69, 0.80). The association between online prescription drug monitoring programs and heroin-related hospitalization was also negative but tended to increase in later years. Counties with lower rates of noncancer pain conditions experienced a lower decrease in prescription opioid overdose and a faster increase in heroin overdoses. No differences were observed across different county levels of poverty and unemployment.

CONCLUSIONS

Areas with lower levels of noncancer pain conditions experienced the smallest decrease in prescription opioid overdose and the faster increase in heroin overdose following implementation of online prescription drug monitoring programs. Our results are consistent with the hypothesis that prescription drug monitoring programs are most effective in areas where people are likely to access opioids through medical providers.

Authors+Show Affiliations

From the Violence Prevention Research Program, Department of Emergency Medicine, UC Davis School of Medicine, Sacramento, CA. Society and Health Research Center, Facultad de Humanidades, Universidad Mayor, Santiago, Chile.Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, CA.Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, CA.Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, CA.Department of Epidemiology, Brown University School of Public Health, Providence, RI.Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY.Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY.From the Violence Prevention Research Program, Department of Emergency Medicine, UC Davis School of Medicine, Sacramento, CA.From the Violence Prevention Research Program, Department of Emergency Medicine, UC Davis School of Medicine, Sacramento, CA.From the Violence Prevention Research Program, Department of Emergency Medicine, UC Davis School of Medicine, Sacramento, CA. Department of Population Health, NYU School of Medicine, New York, NY.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30721165

Citation

Castillo-Carniglia, Alvaro, et al. "Prescription Drug Monitoring Programs and Opioid Overdoses: Exploring Sources of Heterogeneity." Epidemiology (Cambridge, Mass.), vol. 30, no. 2, 2019, pp. 212-220.
Castillo-Carniglia A, Ponicki WR, Gaidus A, et al. Prescription Drug Monitoring Programs and Opioid Overdoses: Exploring Sources of Heterogeneity. Epidemiology. 2019;30(2):212-220.
Castillo-Carniglia, A., Ponicki, W. R., Gaidus, A., Gruenewald, P. J., Marshall, B. D. L., Fink, D. S., Martins, S. S., Rivera-Aguirre, A., Wintemute, G. J., & Cerdá, M. (2019). Prescription Drug Monitoring Programs and Opioid Overdoses: Exploring Sources of Heterogeneity. Epidemiology (Cambridge, Mass.), 30(2), 212-220. https://doi.org/10.1097/EDE.0000000000000950
Castillo-Carniglia A, et al. Prescription Drug Monitoring Programs and Opioid Overdoses: Exploring Sources of Heterogeneity. Epidemiology. 2019;30(2):212-220. PubMed PMID: 30721165.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prescription Drug Monitoring Programs and Opioid Overdoses: Exploring Sources of Heterogeneity. AU - Castillo-Carniglia,Alvaro, AU - Ponicki,William R, AU - Gaidus,Andrew, AU - Gruenewald,Paul J, AU - Marshall,Brandon D L, AU - Fink,David S, AU - Martins,Silvia S, AU - Rivera-Aguirre,Ariadne, AU - Wintemute,Garen J, AU - Cerdá,Magdalena, PY - 2019/2/6/entrez PY - 2019/2/6/pubmed PY - 2019/5/21/medline SP - 212 EP - 220 JF - Epidemiology (Cambridge, Mass.) JO - Epidemiology VL - 30 IS - 2 N2 - BACKGROUND: Prescription drug monitoring program are designed to reduce harms from prescription opioids; however, little is known about what populations benefit the most from these programs. We investigated how the relation between implementation of online prescription drug monitoring programs and rates of hospitalizations related to prescription opioids and heroin overdose changed over time, and varied across county levels of poverty and unemployment, and levels of medical access to opioids. METHODS: Ecologic county-level, spatiotemporal study, including 990 counties within 16 states, in 2001-2014. We modeled overdose counts using Bayesian hierarchical Poisson models. We defined medical access to opioids as the county-level rate of hospital discharges for noncancer pain conditions. RESULTS: In 2010-2014, online prescription drug monitoring programs were associated with lower rates of prescription opioid-related hospitalizations (rate ratio 2014 = 0.74; 95% credible interval = 0.69, 0.80). The association between online prescription drug monitoring programs and heroin-related hospitalization was also negative but tended to increase in later years. Counties with lower rates of noncancer pain conditions experienced a lower decrease in prescription opioid overdose and a faster increase in heroin overdoses. No differences were observed across different county levels of poverty and unemployment. CONCLUSIONS: Areas with lower levels of noncancer pain conditions experienced the smallest decrease in prescription opioid overdose and the faster increase in heroin overdose following implementation of online prescription drug monitoring programs. Our results are consistent with the hypothesis that prescription drug monitoring programs are most effective in areas where people are likely to access opioids through medical providers. SN - 1531-5487 UR - https://www.unboundmedicine.com/medline/citation/30721165/Prescription_Drug_Monitoring_Programs_and_Opioid_Overdoses:_Exploring_Sources_of_Heterogeneity_ L2 - https://doi.org/10.1097/EDE.0000000000000950 DB - PRIME DP - Unbound Medicine ER -