Prescription Drug Monitoring Programs on Oxycodone Prescriptions, Heroin Substitution, and Crime Rates

In response to growing abuse of prescription opioid painkillers, 49 U.S. states have implemented electronic prescription drug monitoring programs which record patients into a state-wide system when a prescription opioid is received. In response to low prescriber utilization of the prescription monitoring databases, 12 states passed legislation that strengthened the prescription monitoring programs by legally requiring prescribers to use the systems. This paper uses a difference-in-differences regression framework and interactive fixed effects factor models to identify the effect of the early prescription drug monitoring programs and subsequent legislation that strengthened the programs on the types and strengths of opioid painkiller prescriptions filled and on drug crime rates. The initial implementation of prescription drug monitoring databases caused a decrease in the amount of oxycodone and strong-dose oxycodone among the Medicaid population. PDMPs cause an increase in the number of crime incidents where an offender is carrying heroin. PDMPs do not affect the number of drug dealers selling heroin, suggesting a demand-side response, which indicates that abusers of high-dose pills substitute to heroin in response to the additional obstacles a PDMP imposes to obtaining prescription opioids. PDMPs have an ambiguous effect on illegally obtained prescription opioids because the databases create opposing market forces. There is no evidence that a mandate requiring that prescribers use the PDMP reduces prescriptions further, and no evidence of the mandates affecting drug crime rates.