In Reply Mr Rudman and colleagues question whether mandatory review of PDMP data reduces opioid overdose death rates. They observe that the 4 states with mandated PDMP policies examined in one study1 each experienced increases in heroin-related and overall opioid-related overdose death rates from 2011 to 2015. In fact, nearly all states experienced increases in these rates since 1999, including from 2011 to 2015. Therefore, an evaluation of any state-level policy during this period would seem to imply that the policy was associated with increased overdose deaths. To differentiate background trends and other variables across states, Dowell et al1 used a difference-in-difference regression analysis and compared changes in overdose death rates associated with policies vs changes in rates absent policy intervention. The analysis found that specific policies (eg, mandated PDMP use and pain clinic laws) were associated with reduced prescription opioid–related overdose deaths and overall opioid–related overdose deaths (including those from prescription opioids and heroin). Using this method, these policies were associated with reduced heroin deaths, although this association was not statistically significant.1
Schuchat A, Guy GP, Dowell D. Prescription Drug Monitoring Programs and Opioid Death Rates—Reply. JAMA. 2017;318(20):2045. doi:10.1001/jama.2017.16304
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