The Impact of Mandated Prescription Drug Monitoring Program Registration on Prescription Opioid-Related Mortality in California

OBJECTIVES: Drug-related overdose deaths nearly quadrupled between 1999 and 2018 in US. Between 2008 and 2014, California accounted for 9.6% of US prescription opioid-related deaths. California implemented a pivotal mandate aimed at controlling prescription opioid misuse, which required prescribers to consult CURES before prescribing, ordering, administrating, or furnishing Schedule II-IV controlled substances, which became effective in October 2018. Therefore, the objective of this study was to conduct a comparison of opioid prescriptions and mortality attributed to prescription opioids before and after the 2018 mandate.

METHODS: Data from 2015 to 2018 (pre-mandate) and 2019 to 2022 (post-mandate) regarding opioid prescription count and pre- and post-mandate opioid prescription overdose deaths were compiled from The California Opioid Overdose Surveillance Dashboard. Descriptive statistics and a two-sample t-test were employed to assess the change in mean deaths from pre-mandate to post-mandate.

RESULTS: Before the mandate, opioid prescriptions totaled 88,650,538, and after the mandate, they decreased to 60,458,781. Descriptive statistics showed pre-mandate mean and standard deviation of (22,162,630, SD=1,893,328) and post-mandate (15,114,695, SD= 1,658,434). The total number of deaths reported due to prescription opioids were 6,183 and 21,198 pre-mandate and post-mandate, respectively. The mean deaths due to prescription opioids during the pre-mandate period was (1,546, SD= 164.86) and post-mandate period (5,300, SD=2,126.67). The results indicate a statistically significant difference in the number of deaths pre-mandate and post-mandate (p=0.012).

CONCLUSIONS: The study results demonstrate a substantial reduction in opioid prescriptions post-mandate, while the number of deaths due to prescription opioids has significantly increased. Opioid prescriptions have declined as they have become more controlled and restricted. Nevertheless, these restrictions have not resulted in reduced opioid-related harm. It may suggest that individuals who misuse opioids are seeking out illicit sources when faced with tighter restrictions.