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More Evidence That Prescription Drug Monitoring Programs Might Increase Overdose Deaths

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Jeffrey A. Singer

At a Cato Institute policy forum in October 2019, Columbia University public health researcher David Fink presented data showing that Prescription Drug Monitoring Programs (PDMPs), designed to surveil opioid prescribing by health care practitioners to their patients in pain, have no appreciable effect on the fatal or non‐​fatal opioid overdose rate, but may have the unintended consequence of increasing overdoses from heroin. I have cited his work, along with the work of others, that draw similar conclusions.

Now researchers at Indiana University are providing even more evidence that PDMPs, along with prescription limit laws and other interventions, “may have the unintended consequence of motivating those with opioid use disorders to access the illicit drug market, potentially increasing overdose mortality.”

Their research, published in JAMA on February 12, 2021, was a cross‐​sectional study that utilized overdose mortality data from the National Vital Statistics System, and claims data from 23 million commercially insured patients provided by the Optum Clinformatics Data Mart Database (a large de‐​identified database) for the years 2007 through 2018.

In the discussion of their findings, the authors made note of what they called the opioid paradox:

Recent trends in the US opioid epidemic present a paradox: opioid overdose mortality has continued to increase despite declines in opioid prescriptions since 2012. The opioid paradox may arise from the success—not failure—of state interventions to control opioid prescriptions… We found that supply‐​controlling policies were associated with a reduction in the amount of prescription opioid misuse and the number of overdose deaths attributable to natural opioids as well as an increase in the number of patients receiving MAT drugs. In tandem, the significant increase of overdose deaths from synthetic opioids [e.g., fentanyl], heroin, and cocaine after the enactment of PDMP access, pain clinic laws, and naloxone access laws suggests that current drug policies may have the unintended consequence of motivating opioid users to switch to illicit drugs.

This validates arguments I have made here and here.

Meanwhile, PDMPs and other measures aimed at reducing the number of opioids practitioners prescribe have had a devastating impact on patients.

Researchers at the University of Pittsburgh reported that drug overdoses from licit and illicit drugs have been increasing at an exponential rate since at least the late 1970s—well before the creation of OxyContin in 1996—with different drugs predominating among the overdoses at different times. They concluded, “The opioid crisis may be part of a larger, longer‐​term process” and speculated that “Sociological and psychological ‘pull’ forces may be operative to accelerate demand, such as despair, loss of purpose, and dissolution of communities.”

Regardless of how sociological and psychological “pull forces” might factor into increases in non‐​medical drug use, the driving force behind fatal and non‐​fatal overdoses is drug prohibition via the dangerous black market it spawned. Now there’s more evidence that PDMPs and other supply‐​side interventions make matters worse by driving more people to that underground market.


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