Association between prescription drug monitoring programs and nonfatal and fatal drug overdoses: A systematic review

David S. Fink, Julia P. Schleimer, Aaron Sarvet, Kiran K. Grover, Chris Delcher, Alvaro Castillo-Carniglia, June H. Kim, Ariadne E. Rivera-Aguirre, Stephen G. Henry, Silvia S. Martins, Magdalena Cerdá

Research output: Contribution to journalReview articlepeer-review

159 Scopus citations


Background: Prescription drug monitoring programs (PDMPs) are a key component of the president's Prescription Drug Abuse Prevention Plan to prevent opioid overdoses in the United States. Purpose: To examine whether PDMP implementation is associated with changes in nonfatal and fatal overdoses; identify features of programs differentially associated with those outcomes; and investigate any potential unintended consequences of the programs. Data Sources: Eligible publications from MEDLINE, Current Contents Connect (Clarivate Analytics), Science Citation Index (Clarivate Analytics), Social Sciences Citation Index (Clarivate Analytics), and ProQuest Dissertations indexed through 27 December 2017 and additional studies from reference lists. Study Selection: Observational studies (published in English) from U.S. states that examined an association between PDMP implementation and nonfatal or fatal overdoses. Data Extraction: 2 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. Data Synthesis: Of 2661 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 3 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 6 studies found an increase in heroin overdoses after PDMP implementation. Limitation: Few studies, high ROB, and heterogeneous analytic methods and outcome measurement. Conclusion: 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.

Original languageEnglish
Pages (from-to)783-790
Number of pages8
JournalAnnals of Internal Medicine
Issue number11
StatePublished - Jun 5 2018

Bibliographical note

Funding Information:
By grant R01 DA039962 from the NIDA, National Institutes of Health (NIH), and grants 2016-PM-BX-K005 and 2015-PM-BX-K001 from the BJA. Mr. Fink is supported by NIDA training grant T32DA031099. The BJA is a component of the Department of Justice's Office of Justice Programs, which include the Bureau of Justice Statistics, National Institute of Justice, Office of Juvenile Justice and Delinquency Prevention, Office for Victims of Crime, and Office of Sex Offender Sentencing, Monitoring, Apprehending, Registering, and Tracking.

Publisher Copyright:
© 2018 American College of Physicians.

ASJC Scopus subject areas

  • Internal Medicine


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