Study: Programs to Limit Prescription Opioids May Spur Illegal Drug Use

Prescription drug monitoring programs have decreased prescription opioids in the United States but resulted in unintended spikes of illegal drug use and heroin-related deaths.

Prescription drug monitoring programs (PDMPs) lowered US opioid prescriptions, but in response, opioid users increased their use of illegal, and often more deadly, drugs, according to a study by researchers at the University of Texas at Dallas.

“There are currently more than 2 million individuals with opioid-use disorder, characterized by chronic abuse of prescription opiates,” said study author Tongil (TI) Kim, assistant professor of marketing in the Naveen Jindal School of Management,in a press release. “With more than 130 people dying from opioid overdose every day, this has become a serious social issue in America.”

According to the policy, prescribers must check prescription history before granting refills on controlled substances. The PDMP is mandated in every state except for South Dakota and Kansas.

States with PDMP mandates observed fewer opioid prescriptions, according to Kim. Although the mandate reinforced proper drug administration, researchers also noticed a spike in opioid users turning to more lethal and illegal drugs.

This observed pattern is not new though, according to the researchers. The main driver of the opioid epidemic begins in the office when physicians overprescribe opioids—usually painkillers. Patients noticeably began to take more than their prescribed amount or turn to more deadly substances.

“Easy access to prescription opioids can further exacerbate opioid dependence and abuse,” Kim said. “Mandated PDMP use can curb such doctor-shopping behavior.”

Kim aimed to determine whether the PDMP policy reduced prescription opioid deaths, explaining that “it is critical to assess whether any curb on the supply of prescription opioids leads to an overall reduction in opioid consumption or whether patients simply seek out illicit alternatives.”

In the study, Kim and team gathered national data on opioid prescriptions and deaths from prescription opioids or heroin between 2006 and 2015 when the PDMP mandates were first coming into effect. The team then used a differences-in-differences approach to evaluate how each state governed the policy.

Additionally, the team analyzed the frequency of keyword searches for prescription opioids (OxyContin and Vicodin) while the PDMP was in effect. Searches for opioids did decrease while PDMPs were enacted, but the frequency of illegal substance keywords such as heroin notably increased.

In measuring overdose deaths, Kim and team found that the policy was effective. Opioid prescriptions decreased by 6.1% during this time, but heroin-related deaths increased more than 50%, which suggests that the policy unintentionally caused greater substitution, according to the study authors.

“Past research has shown that when facing restricted access to addictive substances, individuals simply seek out alternatives rather than limiting consumption,” Kim said in the press release.

“Restricting the availability of illicit substances through increased policing, for example, and investing in treatment capacity can mitigate the unintended consequences of PDMP mandates.”

Reference

University of Texas at Dallas. Study: Has prescription monitoring curbed the opioid epidemic? EurekAlert! August 25, 2022. Accessed on August 26, 2022. https://www.eurekalert.org/news-releases/962850