Are there side effects of Prescription Drug Monitoring Programs?

In an effort to fight the rapidly growing opioid epidemic, U.S. states have implemented Prescription Drug Monitoring Programs (PDMPs), which record patients’ prescription histories. The purpose of PDMPs is to facilitate the detection of suspicious prescribing, abuse, and doctor shopping behavior. However, a typical result of governments’ supply-side anti-drug efforts is the “balloon effect”: when the government closes down a source of drug supply, addicts tend to resort to other sources rather than decrease drug use. PDMPs impede access to unlawful opioid medication, but possibly increase the likelihood that some drug users switch to illicit opiates (e.g., heroin or opioids traded on the black market). In this paper, we study the potential side effects deriving from the introduction of PDMPs, combining data from states’ regulation from the Prescription Drug Abuse Policy System, hospitalization data from the National Inpatient Sample, mortality data from the Centers for Disease Control and Prevention, and crime data from FBI’s Uniform Crime Reporting Program. Using a difference-in-difference approach, we find no effects of PDMP on mortality and crime, but uncover a composition change in hospitalizations. While introducing a PDMP significantly reduces hospitalizations due to prescription opioids abuse (7%), we also observe a strong increase in hospitalizations due to heroin abuse (18%). These excess heroin cases consist of emergency hospitalizations due to drug poisoning, where the patient is most likely a white woman in her twenties, either under Medicare or private insurance. We also find evidence of displacement effects for prescription opioids abuse but not for heroin, which suggests that individuals are prepared to cross a state border to look for prescription opioids, but not in search of heroin. Overall, our results suggest that policies targeted at preventing addicts from switching to illicit opioids (e.g., replacement therapies) would be an effective complement to PDMPs.