Prescription Monitoring Program Mandates and Opioids Dispensed to Patients Dying of Cancer

State legislations mandating prescriber use of Prescription Drug Monitoring Programs (PDMPs) may have the unintended consequence of restricting opioid analgesics to patients dying of cancer. This study aims to assess associations of comprehensive PDMP mandates with opioid-related outcomes for patients dying of cancer, overall and by decedent race and ethnicity.

Study population were Medicare decedents who were age 66 years or older, diagnosed with breast, colorectal, lung, or prostate cancer, and died of cancer in 2011-2019. This cross-sectional study used SEER-Medicare data and a difference-in-differences design. Study sample included decedents from 10 states with an operating PDMP on January 1, 2011. Outcomes included the dichotomous event of having one or more opioid days, total and daily morphine milligram equivalents (MMEs) if having opioids, near the end of life. Generalized linear models were estimated for dichotomous (logit link function) and continuous (log) outcomes.

This study included 115,256 decedents. Comprehensive PDMP mandates were associated with modest reductions in the rate of one or more opioid days (from 45.1% to 43.9%, difference = 0.011 [95% CI, -0.019 to -0.003]), total dose (from 1,600.6 to 1,521.0 MMEs, difference = 79.6 [95% CI, -131.5 to -27.6]), and daily dose from all opioids (from 75.7 to 72.9 MMEs, difference = 2.7 [95% CI, -5.1 to -0.4]). Compared with non-Hispanic White decedents, Black decedents experienced a four-fold reduction, and Asian/Pacific Islander decedents experienced a two-fold reduction, in the rate of one or more opioid days.

Comprehensive PDMP mandates were associated with modest reductions in opioid analgesics dispensed to Medicare patients dying of cancer. Non-Hispanic Black and Asian/Pacific Islander decedents experienced larger reductions.