The Impact of State Opioid Regulations on Pain Management in Medicare Patients

Do efforts to reduce painkiller abuse through prescription drug monitoring programs produce externalities in legitimate pain management? Abuse of prescription opioid painkillers has become an epidemic in the United States. Between 1999 and 2013, both sales of and deaths attributable to opioid analgesics such as OxyContin quadrupled in the U.S. The principal policy response by almost all states has been to implement prescription drug monitoring programs (PDMP) to limit opioid access and reduce the drugs’ negative impacts. PDMPs are online databases that keep records of prescriptions filled for controlled substances, including information on patients, prescribers, and pharmacies. With these data, PDMPs are able to track quantities of prescriptions filled by individuals or issued by prescribers and detect behavior that might be inappropriate. However, opioids play an important role in legitimate pain management. An estimated one-third of the U.S. population struggles with chronic pain, and opioid painkillers are sometimes the only suitable treatments. Of particular concern are individuals in vulnerable populations—those in hospice and in nursing homes—who may have a high incidence of pain and greater susceptibility to spillovers inadvertently imposed by restricted access to drugs. No study has examined PDMPs’ potential for impacts on legitimate pain management. We provide an initial but in-depth look at the relationship between PDMPs and pain management using 2000-2011 individual-level patient data from the Medicare Current Beneficiary Survey (MCBS). We analyze the effect of PDMPs on pain outcomes and limitations on the activities of daily living, first for the general Medicare population (individuals over 65 years old) and separately for nursing home and hospice patients. Because policy adoption is potentially endogenous, we employ a fixed-effects two-stage least squares model using state-level instrumental variables to predict a state’s likelihood of establishing a PDMP. This study’s findings will inform policymakers about the potential for unintended consequences (either positive or negative) of opioid regulation for pain management and will make health care providers aware of possible changes in patient pain outcomes as a result of the prescription drug monitoring programs.