Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York.
Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York.
Epidemiol Rev. 2020 Jan 31;42(1):134-153. doi: 10.1093/epirev/mxaa002.
Prescription drug monitoring programs (PDMPs) are a crucial component of federal and state governments' response to the opioid epidemic. Evidence about the effectiveness of PDMPs in reducing prescription opioid-related adverse outcomes is mixed. We conducted a systematic review to examine whether PDMP implementation within the United States is associated with changes in 4 prescription opioid-related outcome domains: opioid prescribing behaviors, opioid diversion and supply, opioid-related morbidity and substance-use disorders, and opioid-related deaths. We searched for eligible publications in Embase, Google Scholar, MEDLINE, and Web of Science. A total of 29 studies, published between 2009 and 2019, met the inclusion criteria. Of the 16 studies examining PDMPs and prescribing behaviors, 11 found that implementing PDMPs reduced prescribing behaviors. All 3 studies on opioid diversion and supply reported reductions in the examined outcomes. In the opioid-related morbidity and substance-use disorders domain, 7 of 8 studies found associations with prescription opioid-related outcomes. Four of 8 studies in the opioid-related deaths domain reported reduced mortality rates. Despite the mixed findings, emerging evidence supports that the implementation of state PDMPs reduces opioid prescriptions, opioid diversion and supply, and opioid-related morbidity and substance-use disorder outcomes. When PDMP characteristics were examined, mandatory access provisions were associated with reductions in prescribing behaviors, diversion outcomes, hospital admissions, substance-use disorders, and mortality rates. Inconsistencies in the evidence base across outcome domains are due to analytical approaches across studies and, to some extent, heterogeneities in PDMP policies implemented across states and over time.
处方药物监测计划（PDMP）是美国联邦政府和州政府应对阿片类药物流行的重要组成部分。关于 PDMP 在减少处方类阿片相关不良后果方面的有效性的证据参差不齐。我们进行了一项系统评价，以研究在美国实施 PDMP 是否与以下 4 个与处方类阿片相关的结果领域的变化相关：阿片类药物处方行为、阿片类药物转移和供应、阿片类药物相关发病率和物质使用障碍、以及阿片类药物相关死亡。我们在 Embase、Google Scholar、MEDLINE 和 Web of Science 中搜索了符合条件的出版物。共有 29 项研究在 2009 年至 2019 年期间发表，符合纳入标准。在 16 项研究 PDMP 和处方行为的研究中，有 11 项研究发现实施 PDMP 减少了处方行为。关于阿片类药物转移和供应的所有 3 项研究均报告了所检查结果的减少。在阿片类药物相关发病率和物质使用障碍领域，有 8 项研究中的 7 项发现与处方类阿片相关结果存在关联。在阿片类药物相关死亡领域的 8 项研究中有 4 项报告了死亡率降低。尽管存在混合的发现，但新出现的证据支持实施州 PDMP 可减少阿片类药物处方、阿片类药物转移和供应以及阿片类药物相关发病率和物质使用障碍的结果。当检查 PDMP 特征时，强制性访问规定与减少处方行为、转移结果、住院、物质使用障碍和死亡率有关。不同结果领域的证据基础不一致是由于研究之间的分析方法不同，以及在一定程度上，各州实施的 PDMP 政策随时间推移而存在差异。
