Impact of Prescription Drug Monitoring Programs on Postpartum Opioid Prescribing Practices
本研究评估了2007至2015年间美国州级处方药监测计划（PDMP）与产后阿片类药物处方的关联，发现PDMP实施并未显著改变产后阿片类药物的处方量，提示仅靠PDMP可能不足以影响产后处方行为。
OBJECTIVE: 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. STUDY SETTING AND DESIGN: 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). DATA SOURCES AND ANALYTIC SAMPLE: 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. PRINCIPAL FINDINGS: 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. CONCLUSION: 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.