University of Iowa researchers looked at 13 years of state PDMP policy and found that mandatory use alone was followed by less buprenorphine reaching pharmacies, while states that paired a mandate with EHR integration saw more methadone reach treatment programs.

By PDMPNews Staff

Source: Johnson et al., Drug and Alcohol Dependence, Nov. 1, 2024 (online Aug. 29, 2024) (DOI)

This write-up is based on the published abstract only. The full text is paywalled and was not reviewed.

What happened

States have used two main levers to get prescribers to check their PDMP. Mandatory use policies require a check in set circumstances. Integration puts PDMP data inside the electronic health record so a clinician does not have to log in to a separate website. Research has shown PDMPs can reduce opioid prescribing for pain, but much less is known about whether they help or hurt access to medications for opioid use disorder (MOUD).

A team from the University of Iowa College of Public Health and Carver College of Medicine tested that question across all 50 states and the District of Columbia from 2009 to 2021. They tracked four outcomes: buprenorphine distributed to opioid treatment programs, buprenorphine distributed to pharmacies, methadone distributed to opioid treatment programs, and total methadone and buprenorphine combined. The analysis used a Callaway and Sant’Anna difference-in-differences model, which compares states as they adopt a policy at different times, and it controlled for other opioid-related state policies in effect at the same time.

Key numbers

  • After mandatory use policies took effect, buprenorphine distribution to pharmacies fell 8% (95% CI, down 14% to down 1%).
  • Where states had both integration and a mandate, methadone distribution to opioid treatment programs rose 17% (95% CI, up 4% to up 34%).
  • Under both policies together, combined methadone and buprenorphine distribution rose 6% (95% CI, 0% to up 14%). The lower bound sits at zero, so this estimate is not clearly different from no change.
  • The authors note that less than a quarter of people with opioid use disorder currently receive these medications.

The authors describe the overall result as “a small net benefit” of integration and mandatory use on MOUD distribution. The abstract does not explain why pharmacy buprenorphine fell under mandates alone, and the full text was not available for this review.

Why it matters for PDMPs

PDMP mandates were built to curb risky opioid prescribing, not to manage the treatment supply. This study is a reminder that the same policy can reach both. Buprenorphine prescribed outside opioid treatment programs, including by telemedicine, is generally filled at pharmacies, so an 8% drop in what reaches those pharmacies is worth attention from any program whose state is weighing a new or broader mandate.

The more encouraging finding is about integration. When the check was part of the EHR workflow and paired with a requirement, the estimates were more favorable, although the combined estimate was not clearly different from no change. A companion paper by the same group in JAMIA describes why integration matters: early PDMPs were standalone websites that required a separate login outside the EHR, and integration was designed to put the data directly in clinical workflows. That paper also found that states with more prior opioid dispensing, more neonatal opioid withdrawal syndrome hospitalizations, and more prior opioid policies were more likely to adopt mandates, while no measured factor predicted integration.

What has happened since

The data in this study end in 2021. Since then, federal rules have tied PDMP review directly to buprenorphine access. Under 21 CFR 1306.51, which took effect Dec. 31, 2025 after two delays (90 FR 13410), a practitioner prescribing buprenorphine for opioid use disorder by telemedicine without an in-person visit must first review PDMP data for the state where the patient is located. Through Dec. 31, 2026, practitioners may also prescribe under the temporary COVID-era telemedicine flexibilities, which impose fewer requirements (90 FR 61301). That makes the question this study raised, whether PDMP requirements help or slow treatment, more pressing rather than less. PDMPNews covered a separate DEA proposal from January 2025, for a telemedicine special registration, in The End of the Wild West.

Analysis

Three cautions. First, these are distribution figures, meaning medication shipped to pharmacies and treatment programs. They are a proxy for treatment, not a count of patients treated. Second, a difference-in-differences design can account for timing and other policies, but it cannot rule out every change that happened alongside a mandate. Third, this review is based on the abstract, so details such as the data source and how each state’s integration date was set could not be checked here.

For PDMP administrators, the practical lesson is that mandate design and integration should be treated as one decision. A requirement with no easy path to compliance adds friction at the moment a patient is trying to start or stay on treatment. A requirement delivered inside the EHR, with treatment medications clearly labeled in the patient report, is more likely to support care than slow it. States reviewing mandate language could also consider whether buprenorphine for opioid use disorder needs the same check triggers as opioids prescribed for pain. That is a policy question the study raises but does not answer.

Read the abstract: PubMed 39241503