MANDATED PRESCRIPTION DRUG MONITORING PROGRAMS AND CHANGES IN ADOLESCENT INJECTION DRUG USE

Purpose: Prescription opioid misuse among adolescents remains an ongoing public health problem and is a risk factor for injection drug use (IOU), but few studies have evaluated strategies for preventing adolescent initiation of IOU. To reduce the prescription opioid supply, almost all states have prescription drug monitoring programs (PDMPs). Many states mandate that clinicians use the POMP before prescribing any controlled substances. The extent to which these 'POMP mandates' might protect against substance use and IOU among adolescents is unknown. We sought to evaluate the relationship between state POMP mandates and adolescent IOU. Methods: We used biannual Youth Risk Behavioral Surveillance System (YRBSS) individual-level data representative of adolescents aged 17-18 years across 47 states from 1995 to 2017. Using a differencein-differences design, we evaluated changes in the percent of adolescents reporting lifetime IDU before and after POMP mandates in 18 states that implemented mandates prior to January 1, 2017, compared to changes in IDU over time in 29 states without POMP mandates. We estimated linear regression models controlling for individual age, sex, race/ethnicity, state, year, and state-level poverty with standard errors clustered by state and standard YRBSS survey weights. Sensitivity analyses examined whether any potential changes in adolescent IDU might have begun to occur prior to POMP mandates, as well as whether changes were sustained for at least two years beyond implementation. We used US Census Bureau data to estimate the number of adolescents who might have been prevented from initiating IDU if all states had implemented POMP mandates. Results: Among 331,025 students, 51.7% identified as male, 62.1% as non-Hispanic white, 17.4% as non-Hispanic black, 14.6% as Hispanic, and 5.9% as another race or ethnicity. Among all adolescents, 3.5% (95% confidence interval [0], 2.8 to 4.2%) reported IDU prior to POMP mandates. Baseline trends in IDU did not differ in states that did and did not mandate PDMPs (point estimate,