Impact of Prescription Drug Monitoring Programs on Postpartum Opioid Prescribing Practices

To evaluate the association between Prescription Drug Monitoring Programs (PDMPs) and postpartum opioid prescribing from 2007 to 2015, prior to the 2016 Centers for Disease Control and Prevention opioid prescribing guidelines, and to assess differences between low- and high-risk populations.

This cross-sectional study captures delivery episodes across the United States, primarily from commercially insured patients. The exposure was the implementation of PDMPs at the state level from 2007 to 2015, with states classified by whether implementation occurred before or after 2016. We used a difference-in-difference design for analysis. The primary outcome included: (1) morphine milligram equivalents (MME) per day; (2) pills dispensed; (3) average days' supply, and (4) total number of prescriptions filled during the postpartum period (42 days after delivery).

We analyzed secondary data from IQVIA PharMetrics, an administrative claims database from 2006 to 2015. We identified reproductive-age patients (ages 12-59) with a documented delivery and stratified them into low and high-risk groups by postpartum prescribing and pre-delivery opioid exposure.

Among 361,165 delivery episodes (9.9% cesarean, 90.1% vaginal), PDMP implementation was not associated with changes in postpartum opioid prescribing. In an age-and comorbidity-adjusted analysis by risk groups, PDMP implementation was not associated with statistically significant changes in MME per day per delivery in either low-risk (-0.35; 95% CI, -3.27 to 2.57) or high-risk groups (1.11; 95% CI, -7.46 to 9.68) in the implementation year, and results for pills dispensed, days' supply, and total prescriptions were similarly null, with confidence intervals spanning zero.

State-level PDMP implementation was not associated with changes in postpartum opioid prescribing. These findings suggest PDMPs alone may be insufficient to influence postpartum prescribing, highlighting the need for alternative strategies to optimize pain management and reduce opioid-related risks.