Effect of State Mandatory Review of Prescription Drug Monitoring Program and Pain Clinic Laws in Kentucky on Outcomes among Reproductive-Age Women

Objectives: The rise of the opioid epidemic in the U.S. has substantially affected women and newborns, evidenced by the increasing rates of opioid use disorder (OUD) at delivery and neonatal abstinence syndrome. Many states have adopted prescription drug monitoring programs (PDMPs, electronic databases used to monitor controlled-substance prescribing) and pain clinic laws (legislation regulating facilities that prescribe controlled-substances) to reduce opioid prescribing. Previous studies have shown these policies to effectively reduce overall and inappropriate prescribing of opioids and prescription opioid overdose rates among the general population. There is benefit in understanding how these policies impact prescription opioid or heroin OUD and overdose among reproductive-age women given potential impacts on maternal and infant outcomes. This study estimates the impact of combined implementation of a PDMP mandate that requires providers to use PDMP systems before prescribing opioids and pain clinic laws in Kentucky on rates of prescription opioid overdose, heroin overdose, and OUD among reproductive-age women.

Methods: We used 2010-2014 State Inpatient Databases and State Emergency Department Databases from the Healthcare Cost and Utilization Project. We conducted a comparative interrupted time series analysis, estimating outcome changes after the policies were implemented in Kentucky (July 2012), comparing to North Carolina, an nearby state with neither a PDMP mandate nor pain clinic laws in place during the study period. Outcome measures included the monthly rates of emergency department (ED) visits and inpatient discharges related to prescription opioid overdose, heroin overdose, and OUD, respectively, among reproductive-age women (aged 15-44 years) in the state (per 100,000 women). Outcome measures are not mutually exclusive. Segmented linear regression was used to estimate the immediate post-policy change in the outcome (“level” change) and the change in the time trend of outcome (“slope” change) before and after policy implementation in Kentucky comparing with North Carolina, accounting for autocorrelation.

Results: Compared with North Carolina, we found an immediate level decrease (-2.9 per 100,000 women [p<0.01]) and a decreasing trend (slope change = -0.1 per 100,000 women [p<0.01]) in ED and inpatient discharges associated with prescription opioid overdose following policy implementation in Kentucky. Conversely, we found an immediate level increase in ED and inpatient discharges associated with heroin overdose (1.3 per 100,000 women [p<0.01]) following policy implementation. We also found a decreasing trend in OUD-associated discharges (slope change = -0.6 per 100,000 women [p<0.01]) after policy implementation.

Conclusions: Kentucky’s combined implementation of mandatory provider review of the PDMPs and pain clinic laws was associated with an immediate and sustained reduction in prescription opioid overdose discharges among reproductive-age women. Despite a potential substitution effect (e.g., level increase in heroin overdose discharges), policy implementation was associated with a slowing of the increasing trend of OUD-related discharges among reproductive-age women. Our findings suggest that mandated provider review of the PDMP and state regulation for pain management clinics are promising strategies to reduce the adverse impact of opioids among reproductive-age women. However, additional multi-prong public health interventions are needed to reduce heroin overdose and address treatment needs of women to further improve maternal and newborn outcomes.