A Multifaceted Evaluation of the Effectiveness of the Prescription Opioid Policy Response on County-Level Mortality

Over 20,000 deaths in the United States in 2015 were attributable to prescription opioid overdose with another 13,000 deaths associated with heroin overdose. The American opiate epidemic has grown since the early 2000s and continues to worsen, with devastating consequences for families and communities. States have adopted a variety of policies targeted at preventing opioid abuse addition, diversion, and overprescribing. These include prescription drug monitoring programs (in their diverse forms) (PDMP), painkiller clinic regulation (i.e., “Pill Mill Laws”), and Naloxone access laws. Several studies in recent years have analyzed these policies in isolation and attempted to evaluate their effectiveness in reducing opioid abuse and overdose. Results from these studies have been mixed, but more importantly, they ignore the dynamic nature of the opioid policy environment over the past decade. We propose a multifaceted analysis of these policies by measuring their impact on county-level mortality rate data from the Centers for Disease Control and Prevention from 2000 to 2015. We model the following policy characteristics of states during the time period—if a state has an operational online PDMP, if the PDMP requires physician consultation, if the PDMP explicitly does not require consultation, if the PDMP requires daily pharmacy reporting, if the state has painkiller clinic regulations in place, if the state has Naloxone “Good Samaritan” laws, and if Naloxone is available through third-party prescriptions. Further, by analyzing the impact of these policies for counties at various percentiles of population nationally, we find that policies have very different effects in urban compared to rural settings. Through this approach, we develop an index for policy effectiveness that can help states more carefully target their policy response to the growing opioid public health crisis.