States have responded to the opioid epidemic by implementing statewide prescription drug monitoring programs (PDMPs). By helping identify patients at “high risk” for suspected misuse, diversion, and doctor shopping, mandatory PDMPs aim to reduce prescription-opioid misuse and related overdose mortality. So far, however, there is little research on whether prescribing declines following mandatory PDMP laws were targeted toward patient-age groups with a higher incidence of prescription-opioid misuse. To examine the heterogeneous impacts of state laws on different patient-age groups, this study exploits the implementation of PDMP reforms in Kentucky starting July 20, 2012. The analysis uses novel data from PDMPs, including the universe of opioid prescriptions dispensed between January 2012 and November 2013. Individual prescriber-level difference-in-differences, with Indiana as the control state, show that practitioners responded to Kentucky's new laws as expected, by prescribing opioids to fewer patients and authorizing fewer prescriptions and days of supply per prescription. Opioid prescribing declined most sharply to patient sub-populations with the highest past incidence of prescription-opioid-involved overdose mortality—ages 25–54 years. Considering the implication for overdose mortality, we find that Kentucky's PDMP reform was associated with significant declines in prescription-opioid overdose deaths, particularly among adolescents and younger adults (ages 15–34 years). However, the decline in prescription-opioid-involved mortality was offset by an increase in illicit-drug mortality, resulting in no net change in total drug-overdose mortality in Kentucky following its mandatory PDMP.

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处方药监管法对所有人都有效吗？来自行政数据的证据

各州通过实施全州处方药监测计划 (PDMP) 来应对阿片类药物的流行。通过帮助识别疑似滥用、转移和医生购物的“高风险”患者，强制性 PDMP 旨在减少处方阿片类药物滥用和相关的过量死亡率。然而，到目前为止，关于遵循强制性 PDMP 法律减少处方是否针对处方阿片类药物滥用发生率较高的患者年龄组的研究很少。为了检查州法律对不同患者年龄组的异质性影响，本研究利用肯塔基州自 2012 年 7 月 20 日开始实施的 PDMP 改革。该分析使用来自 PDMP 的新数据，包括 2012 年 1 月至2013年11月。以印第安纳州作为对照州的个体处方者级别的差异表明，从业者对肯塔基州的新法律做出了预期的反应，通过向较少的患者开出阿片类药物并授权较少的处方和每张处方的供应天数。对于过去发生处方阿片类药物过量死亡率最高的患者亚群（25-54 岁），阿片类药物的处方下降幅度最大。考虑到过量死亡的影响，我们发现肯塔基州的 PDMP 改革与处方阿片类药物过量死亡的显着下降有关，尤其是在青少年和年轻成人（15-34 岁）中。然而，处方阿片类药物死亡率的下降被非法药物死亡率的增加所抵消，