(P-534) Impacts of Prescription Drug Monitoring Program on Patients with Cancer

Background: Prescription Drug Monitoring Program (PDMP) rigor varies substantially across states but their effects on pain management in cancer patients remains unknown.

Objectives: The objective of this study is to examine the impact of PDMP rigor on opioid utilization among patients with cancer.

Methods: A retrospective cohort study of new cancer patients aged 18-64 years in IQVIA PharMetrics® Plus who were continuously enrolled 12 months pre- and post- cancer diagnosis. PDMP rigor was assessed in states using registration and query mandates and classified into four categories: registration AND query, query only, registration only, and no mandate exposure (reference). Primary outcomes included individual-level opioid prevalent use, total days supplied, and morphine equivalent daily dose (MEDD) in the 12-months following cancer diagnosis. Generalized estimating equations modeled prevalent opioid use among all individuals to account for patients’ correlation within a state; and generalized linear models with robust sandwich estimators modeled total days supplied and MEDD among opioid users.

Results: Of 28,353 eligible individuals, 3,899 (13.8%), 3,459 (12.2%), 2,764 (9.7%), and 18,231 (64.3%) exposed to registration AND query, query only, registration only, and no mandates, respectively, and 10,656 (37.6%) were prescribed opioids post-cancer. Prevalent opioid use was not significantly associated with registration and/or query mandates. Query mandates, alone or with registration mandates, were associated with about 12 fewer days supplied (p < 0.01) compared to unexposed but had no significant association with MEDD. Registration only mandates were associated with 21 days greater (p < 0.01) total days supplied and 1.1 mg (p <0.05) lower MEDD.

Conclusions: Fewer days supplied in cancer patients exposed to query mandates suggests that query mandates are a stronger tool used to reduce opioid dispensing in PDMPs than registration mandates. As more states include PDMP exemptions for patients with cancer and other groups, policy makers should consider the unintended impacts of mandates to reduce high-risk opioid utilization in the general population due to the spillover effects on at-risk patients.