Prescription Drug Monitoring Program Mandates and Opioids Dispensed Following Emergency Department Encounters for Patients With Sickle Cell Disease or Cancer With Bone Metastasis

Patients with sickle cell disease (SCD) or cancer with bone metastasis often present to the emergency department (ED) for treatment of severe pain,1,2 and opioid analgesics remain first-line therapies for acute pain in the ED or after discharge. Policies aimed at improving the safety of opioid prescribing, such as state legislative mandates that prescribers register with or use prescription drug monitoring programs (PDMPs),4 may inadvertently limit access to opioids for these patients. We examined the association between implementation of PDMP mandates and changes in opioids dispensed to these patients following ED encounters. Of the 29 states included, 17 implemented a noncomprehensive mandate by the end of 2017, of which 7 transitioned from noncomprehensive to comprehensive. Five states implemented a comprehensive mandate without having a prior mandate. Study samples included 18-345 ED encounters by 6239 patients with SCD and 26427 ED encounters by 14--389 patients with cancer with bone metastasis.