# Prescription drug monitoring programs and perioperative opioid prescribing and adverse events

## TL;DR

This study found that laws requiring doctors to check prescription drug monitoring programs before prescribing opioids did not change how much opioids were prescribed or post-surgery outcomes.

## Contribution

The study is the first to evaluate the impact of PDMP mandates on perioperative opioid prescribing and adverse events using Medicare claims data.

## Key findings

- PDMP mandates were not associated with changes in opioid prescribing practices.
- No significant differences were observed in post-surgical adverse events.
- Results were consistent across patients with prior substance use and in states with strict mandates.

## Abstract

Most states mandate clinicians to review prescription drug monitoring program (PDMP) databases before prescribing opioids, but the association with perioperative outcomes is unknown.

We analyzed 2016-2019 Medicare claims for patients ≥65 undergoing surgery in 21 states that enacted PDMP use mandates in 2017-2018 vs states without mandates during 2016-2019. Procedure-level, difference-in-differences models adjusted for patient demographics, prior opioid use, mental health, prior substance use disorders, comorbidities, surgeon specialty, and procedure type. Outcomes included discharge opioid prescriptions, days supplied, total and daily morphine milligram equivalents, high-risk prescribing (≥7-day supply or opioid-benzodiazepine overlap), and 30-day post-discharge adverse events (overdose, emergency department visit, hospitalization, or death).

Among 597 455 procedures for 462 290 patients (mean age 73.3 years; 54.5% female), mandates were not associated with changes in opioid prescribing, high-risk prescribing, or adverse events (difference-in-differences estimate: −0.03% points, 95% CI: −1.0, 0.9). Findings were consistent among patients with prior substance use or in states with stringent mandates.

PDMP use mandates were not associated with changes in perioperative opioid prescribing or post-surgical adverse events, suggesting that policymakers should consider pairing mandates with evidence-based, procedure-specific prescribing guidelines.