Implementation of State Prescription Drug Monitoring Program Mandatory Checking Requirements and Prescribed Opioid...

Implementation of prescription drug monitoring programs requiring mandatory checking when prescribing or dispensing reduces opioid analgesic (OA) prescribing. OA receipt varies by individual-level factors, including HIV status. Mandatory prescription drug monitoring program checking requirements (MPDMPs) may exacerbate inequities if prompts trigger biased decision-making around clinical need for OAs. We examined whether MPDMP implementation was associated with changes in self-reported use of prescribed OAs among women and whether associations varied by HIV status. We conducted staggered adoption difference-in-differences analyses using 11 semi-annual data waves (2014-2019) from the Women's Interagency HIV Study, a multisite observational cohort of women with and without HIV. Among 1,720 women, 71% had HIV; 61% were non-Hispanic Black. €The percentage of participants reporting prescribed OA use at baseline was comparable for women with HIV (16.5%) and without HIV (15.1%) but varied by race/ethnicity (non-Hispanic white 22.9%; non-Hispanic Black 13.6%; Hispanic 14.1%). In the adjusted model controlling for baseline age, race/ethnicity, education, HIV status, and census tract socioeconomic characteristics, MPDMP implementation was associated with a 3.6% percentage-point reduction in the probability prescribed OA use (average treatment effect on the treated = -0.036, 95% confidence interval - 0.060 to - 0.011). There was no significant evidence of variation by HIV status. MPDMPs reduce prescribed OA use in individuals. MPDMP implementation raises important questions about the role of provider bias in balancing reductions in overprescribing with maintaining access to OAs for those with special medical needs. Future research examining subgroups is needed to fully characterize MPDMP benefits and harms.