{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T10:43:07Z","timestamp":1774435387679,"version":"3.50.1"},"reference-count":41,"publisher":"Cambridge University Press (CUP)","issue":"2","license":[{"start":{"date-parts":[[2021,1,1]],"date-time":"2021-01-01T00:00:00Z","timestamp":1609459200000},"content-version":"unspecified","delay-in-days":1096,"URL":"https:\/\/www.cambridge.org\/core\/terms"},{"start":{"date-parts":[[2018,1,1]],"date-time":"2018-01-01T00:00:00Z","timestamp":1514764800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J. Law. Med. Ethics"],"published-print":{"date-parts":[[2018]]},"abstract":"<jats:p>This paper seeks to understand the treatment effect of Prescription Drug Monitoring Programs (PDMPs) on opioid prescription rates. Using county-level panel data on all opioid prescriptions in the U.S. between 2006 and 2015, we investigate whether state interventions like PDMPs have heterogeneous treatment effects at the sub-state level, based on regional and temporal variations in policy design, extent of urbanization, race, and income. Our models comprehensively control for a set of county and time fixed effects, countyspecific and time-varying demographic controls, potentially endogenous time-series trends in prescription rates, and other state-level opioid interventions such as Naloxone Access and Good Samaritan laws, Medicaid expansion, and the provision of Methadone Assistance Treatment. We find that PDMPs are only effective in reducing prescription rates if they obligate doctors to check for patients' history prior to filling out a prescription, but the frequency at which a state requires its PDMP to be updated is irrelevant to its effectiveness. Moreover, the significant treatment effects of PDMPs are almost exclusively driven by urban and predominantly white counties, with the relatively more affluent regions showing greater responsiveness than their less affluent counterparts.<\/jats:p>","DOI":"10.1177\/1073110518782948","type":"journal-article","created":{"date-parts":[[2018,7,18]],"date-time":"2018-07-18T11:39:17Z","timestamp":1531913957000},"page":"387-403","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":41,"title":["The Impact of Prescription Drug Monitoring Programs on U.S. Opioid Prescriptions"],"prefix":"10.1017","volume":"46","author":[{"given":"Ian","family":"Ayres","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amen","family":"Jalal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"56","published-online":{"date-parts":[[2021,1,1]]},"reference":[{"key":"S1073110500025432_bib26","unstructured":"26. Centers for Disease Control and Prevention (CDC), U.S. Prescribing Rate Maps, available at <https:\/\/www.cdc.gov\/drugoverdose\/maps\/rxrate-maps.html> (last visited May 7, 2018)."},{"key":"S1073110500025432_bib24","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2016.1141"},{"key":"S1073110500025432_bib22","article-title":"\u201cAddressing the Opioid Epidemic: Is There a Role for Physician Education?\u201d","author":"Currie","year":"2017","journal-title":"National Bureau of Economic Research"},{"key":"S1073110500025432_bib33","unstructured":"33. See D. I. Rees et al., supra note 9."},{"key":"S1073110500025432_bib38","unstructured":"38. Substance Abuse and Mental Health Services Administration, National Survey of Substance Abuse Treatment Services (N-SSATS) 2000-2016, available at <https:\/\/wwwdasis.samhsa.gov\/dasis2\/nssats.htm>"},{"key":"S1073110500025432_bib32","unstructured":"32. See Prescription Drug Abuse Policy System (PDAPs), supra note 8."},{"key":"S1073110500025432_bib19","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpain.2005.11.006"},{"key":"S1073110500025432_bib27","unstructured":"27. Id."},{"key":"S1073110500025432_bib4","unstructured":"4. Centers for Disease Control and Prevention (CDC), \u201cAnnual Surveillance Report of Drug-Related Risks and Outcomes \u2014 United States, 2017,\u201d Surveillance Special Report 1 (2017): 10; Centers for Disease Control and Prevention (CDC) on the internet: Opioid Prescribing, available at <https:\/\/www.cdc.gov\/vitalsigns\/opioids\/infographic.html> (last visited May 7, 2018)."},{"key":"S1073110500025432_bib37","unstructured":"37. Bureau of Labor Statistics, The Quarterly Census of Employment and Wages (QCEW) 2000-2015, available at <https:\/\/www.bls.gov\/cew\/datatoc.htm> (last visited May 7, 2018)."},{"key":"S1073110500025432_bib15","unstructured":"15. See Rees et al., supra note 9."},{"key":"S1073110500025432_bib17","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa1514387"},{"key":"S1073110500025432_bib7","unstructured":"7. Frakt, A. , \"A Helpful Tool to Combat the Opioid Crisis,\" New York Times, September, 11, 2017, available at <https:\/\/www.nytimes.com\/2017\/09\/11\/upshot\/a-helpful-tool-to-combat-the-opioid-crisis.html?_r=0> (last visited May 7, 2018)."},{"key":"S1073110500025432_bib20","doi-asserted-by":"publisher","DOI":"10.1111\/j.1475-6773.2006.00511.x"},{"key":"S1073110500025432_bib30","unstructured":"30. Urahn, S. K. at al., \u201cPrescription Drug Monitoring Programs, Evidence-Based Practices to Optimize Prescriber Use,\u201d Pew Charitable Trusts, December 2016, available at <http:\/\/www.pewtrusts.org\/~\/media\/assets\/2016\/12\/prescription_drug_monitoring_programs.pdf> (last visited May 7, 2018)."},{"key":"S1073110500025432_bib13","article-title":"\u201cSupply-Side Drug Policy in the Presence of Substitutes: Evidence from the Introduction of Abuse-Deterrent Opioids,\u201d","author":"Alpert","year":"2017","journal-title":"National Bureau of Economic Research"},{"key":"S1073110500025432_bib8","unstructured":"8. Prescription Drug Abuse Policy System (PDAPs), Naloxone Overdose Prevention Laws, available at <http:\/\/pdaps.org\/datasets\/laws-regulating-administration-ofnaloxone-1501695139> (last visited May 7, 2018); PDAPs, Good Samaritan Overdose Prevention Laws, available at <http:\/\/pdaps.org\/datasets\/good-samaritan-overdose-laws-1501695153> (last visited May 7, 2018)."},{"key":"S1073110500025432_bib18","article-title":"\u201cThe Effect of Prescription Drug Monitoring Programs on Opioid Utilization in Medicare,\u201d","author":"Buchmueller","year":"2017","journal-title":"National Bureau of Economic Research"},{"key":"S1073110500025432_bib39","unstructured":"39. Figure 1 of the appendix maps the concentration of prescriptions in counties over time as measured by the Herfindahl\u2014Hirschman Index. We can see from the graph that the decline in prescriptions has been accompanied by a decreased concentration of prescriptions at the county level. Tables 2 and 3 of the appendix show the summary statistics for our data."},{"key":"S1073110500025432_bib6","unstructured":"6. See CDC, supra note 4."},{"key":"S1073110500025432_bib31","unstructured":"31. See J. C. Maclean and B. Saloner, supra note 16."},{"key":"S1073110500025432_bib21","doi-asserted-by":"crossref","first-page":"988","DOI":"10.1016\/j.jpain.2012.07.007","article-title":"\u201cGeographic Variation in Opioid Prescribing in the US,\u201d","volume":"13","author":"Carlson","year":"2012","journal-title":"The Journal of Pain"},{"key":"S1073110500025432_bib3","first-page":"1487","article-title":"\u201cVital Signs: Overdoses of Prescription Opioid Pain Relievers \u2014 United States, 1999\u20142008,\u201d","volume":"60","year":"2011","journal-title":"Morbidity and Mortality Weekly Report"},{"key":"S1073110500025432_bib12","unstructured":"12. Substance Abuse and Mental Health Services Administration (SAMHSA), Number of DATA-Certified Physicians, available at <https:\/\/www.samhsa.gov\/medication-assisted-treatment\/physician-program-data\/certified-physicians> (last visited May 7, 2018). As of 2016 (after our sample ends), the regulations were amended to allow certified physicians to treat treat up to 275 patients. Substance Abuse and Mental Health Services Administration (SAMHSA), Apply to Increase Patient Limits, available at <https:\/\/www.samhsa.gov\/medication-assisted-treatment\/buprenorphine-waivermanagement\/increase-patient-limits> (last visited May 7, 2018)."},{"key":"S1073110500025432_bib9","article-title":"\u201cWith a Little Help from My Friends: The Effects of Naloxone Access and Good Samaritan Laws on Opioid-Related Deaths,\u201d","author":"Rees","year":"2017","journal-title":"National Bureau of Economic Research"},{"key":"S1073110500025432_bib14","article-title":"\u201cMacroeconomic Conditions and Opioid Abuse,\u201d","author":"Hollingsworth","year":"2017","journal-title":"National Bureau of Economic Research"},{"key":"S1073110500025432_bib10","unstructured":"10. See PDAPs, Naloxone Overdose Prevention Laws, supra note 8."},{"key":"S1073110500025432_bib34","unstructured":"34. U.S. Department of Agriculture Economic Research Service, Rural-Urban Continuum Codes, available at <https:\/\/www.ers.usda.gov\/data-products\/rural-urban-continuum-codes\/> (last visited May 7, 2018)."},{"key":"S1073110500025432_bib40","unstructured":"40. They find that while the coefficient of variation (COV) for opioids is 1.09, the COV for total state level health care spending per capita in the U.S. during 2004 was 0.123. See Carlson et al., supra note 21."},{"key":"S1073110500025432_bib25","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2013.07.012"},{"key":"S1073110500025432_bib1","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1146\/annurev-publhealth-031914-122957","article-title":"\u201cThe Prescription Opioid and Heroin Crisis: A Public Health Approach to an Epidemic of Addiction,\u201d","volume":"36","author":"Kolodny","year":"2015","journal-title":"Annual Review of Public Health"},{"key":"S1073110500025432_bib23","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2015.1673"},{"key":"S1073110500025432_bib11","unstructured":"11. Based on an estimate by health care economists Richard G. Frank and Sherry Glied, about 1.3 million people now receive substance abuse treatment due to Medicaid expansion. Zezima, K. and Ingraham, C. , \u201cGOP Health-Care Bill Would Drop Addiction Treatment Mandate Covering 1.3 million Americans,\u201d Washington Post, March 9, 2017, available at <https:\/\/www.washingtonpost.com\/news\/wonk\/wp\/2017\/03\/09\/gop-health-care-bill-would-drop-mental-health-coverage-mandate-covering-1-3-million-americans\/?utm_term=.75d1717f8a2b> (last visited May 7, 2018)."},{"key":"S1073110500025432_bib35","unstructured":"35. Substance Abuse and Mental Health Services Administration (SAMHSA), Number of DATA-Certified Physicians, available at <https:\/\/www.samhsa.gov\/medication-assisted-treatment\/physician-program-data\/certified-physicians> (last visited May 7, 2018)."},{"key":"S1073110500025432_bib29","unstructured":"29. Prescription Drug Monitoring Program Training and Technical Assistance Center, PDMP Legislation & Operational Dates, available at <http:\/\/www.pdmpassist.org\/content\/pdmp-legislation-operational-dates> (last visited May 7, 2018)."},{"key":"S1073110500025432_bib2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsr.2012.08.009"},{"key":"#cr-split#-S1073110500025432_bib36.1","unstructured":"36. U.S. Census Bureau, American Community Survey, 2010-2015, available at <https:\/\/factfinder.census.gov\/faces\/tableservices\/jsf\/pages\/productview.xhtml?pid=ACS155YRDP05&prodType=table> (last visited May 7, 2017)"},{"key":"#cr-split#-S1073110500025432_bib36.2","unstructured":"U.S. Census Bureau, CenStats USA Counties Database 2000-2009, available at: <https:\/\/www.census.gov\/support\/USACdataD-ownloads.html> (last visited May 7, 2018)."},{"key":"S1073110500025432_bib28","unstructured":"28. To calculate prescription rates per 100 persons, CDC used the total number of opioid prescriptions dispensed in a given year and county as the numerator, and divided it by the annual resident population, estimates of which were procured from the Population Estimates Program, U.S. Census Bureau."},{"key":"S1073110500025432_bib16","article-title":"\u201cThe Effect of Public Insurance Expansions on Substance Use Disorder Treatment: Evidence from the Affordable Care Act,\u201d","author":"Maclean","year":"2017","journal-title":"National Bureau of Economic Research"},{"key":"S1073110500025432_bib5","first-page":"563","article-title":"\u201cVital Signs: Variation Among States in Prescribing of Opioid Pain Relievers and Benzodiazepines \u2014 United States, 2012,\u201d","volume":"63","author":"Paulozzi","year":"2014","journal-title":"Morbidity and Mortality Weekly Report"}],"container-title":["Journal of Law, Medicine &amp; Ethics"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1073110518782948","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/1073110518782948","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S1073110500025432","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,1,14]],"date-time":"2021-01-14T17:02:20Z","timestamp":1610643740000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S1073110500025432\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018]]},"references-count":41,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2018]]}},"alternative-id":["S1073110500025432"],"URL":"https:\/\/doi.org\/10.1177\/1073110518782948","relation":{},"ISSN":["1073-1105","1748-720X"],"issn-type":[{"value":"1073-1105","type":"print"},{"value":"1748-720X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018]]}}}