Year of Publication

2015

Degree Name

Doctor of Philosophy (PhD)

Document Type

Doctoral Dissertation

College

Graduate School

Department

Public Policy and Administration

First Advisor

Dr. Jeffery Talbert

Second Advisor

Dr. J.S. Butler

Abstract

Prescription opioid pain reliever utilization has been increasing since the 1990s, due in part to changes in recommendations for the treatment of chronic pain, but also to abuse and diversion. One innovative policy solution to the abuse and diversion of prescription opioids is state prescription drug monitoring programs (PDMPs), which provide prescribers and other selected parties with patient controlled substance dispensation history; thereby, correcting an information asymmetry problem between prescribers and patients.

The widespread implementation of state PDMPs, which vary in program design and requirements, has resulted in a variety of intended and unintended consequences. Previous PDMP evaluations have suggested such outcomes as the reduction of consumer access to opioids, the influencing of healthcare provider prescribing behaviors for opioids, and the re-shaping of the United States market for prescription opioids. PDMPs may also be associated with unintended outcomes: namely, the restriction of pharmaceutical opioids could be associated with an increase in heroin use, as evidenced by increases in heroin substance abuse treatment facility discharges. The analyses in this project examine the influence of PDMPs on healthcare providers and the market for prescription drugs by comparing trends in opioid utilization in states with varying PDMP features using Medicaid prescription utilization data and commercial insurance claims. The effect of PDMPs on consumers is explored with an analysis comparing substance abuse treatment facility discharge data for heroin abuse with pharmaceutical opioid prescriptions before and after PDMP regulatory change. Finally, the impact of other related opioid policy interventions, opioid overdose medication access laws, are analyzed by comparing opioid overdose mortality across states with differing overdose medication access policies over time. Contributions to the understanding about the impacts of these state-level opioid abuse and diversion policies can be used to improve or amplify intended outcomes and ameliorate unintended consequences.

Included in

Health Policy Commons

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