Perceived Unintended Consequences of Prescription Drug Monitoring Programs

Abstract

Background: Opioid-related injuries and deaths continue to present challenges for public health practitioners. Prescription Drug Monitoring Programs (PDMPs) are a prevalent policy option intended to address problematic opioid pain reliever (OPR) prescribing, but previous research has not thoroughly characterized their unintended consequences. Objectives: To examine state actors’ perceptions of the unintended consequences of PDMPs. Methods: We conducted 37 interviews with PDMP staff, law enforcement officials, and administrative agency employees in Florida, Kentucky, New Jersey, and Ohio from May 2015 to June 2016. Results: We identified six themes from the interviews. Perceived negative unintended consequences included: access barriers for those with medical needs, heroin use as OPR substitute and related deaths, and need for adequate PDMP security infrastructure and management. Perceived positive unintended consequences were: community formation and problem awareness, proactive population-level OPR monitoring, and increased knowledge about population-level drug diversion. Conclusions/Importance: State actors perceive a range of both negative and positive unintended consequences of PDMPs. Our findings suggest that there may be unintended risks of PDMPs that states should address, but also opportunities to maximize certain benefits.

Keywords:

• Prescription opioids
• prescription drug monitoring programs
• public health practice
• unintended consequences
• qualitative

Declaration of interest

Dr. Alexander is Chair of the FDA’s Peripheral and Central Nervous System Advisory Committee, serves as a paid consultant to QuintilesIMS, serves on the Advisory Board of MesaRx Innovations, and serves as a paid member of OptumRx’s National P&T Committee. This arrangement has been reviewed and approved by Johns Hopkins University in accordance with its conflict of interest policies. The other coauthors have no conflicts of interest to disclose.

Notes

1 In reporting the results, we labeled the interviewees with the following format: (state name)-(state actor’s agency orientation)-(unique identification number). The state actors sampled in this study were either based in agencies with a health or law-enforcement orientation (with the latter abbreviated as “law”). For example, interviewee “New Jersey-Law-24” refers to a state actor who interacts with the PDMP in New Jersey, is based in an agency with a law enforcement orientation, and has an assigned identification number of 24.

Additional information

Funding

Support for this project was provided by the Robert Wood Johnson Foundation (Project ID 72452). The views expressed here do not necessarily reflect the views of the Robert Wood Johnson Foundation. The funding source had no role in the design and conduct of the study, analysis or interpretation of the data, and preparation or final approval of the manuscript prior to publication.