Policies to Limit Access to Substances

Policy interventions can limit access to substances by regulating how substances are sold and prescribed. Examples of these types of policies include:

• Maintaining Limits in Sales – Reducing the days and hours legal substance sales are allowed can result in a decrease in substance-related injuries and instances. The Community Preventive Services Task Force (CPSTF) has found evidence that limiting times for selling alcoholic beverages is effective for reducing excessive alcohol consumption and other related harms. Limiting the days and hours for alcohol sales has been shown to reduce alcohol-related harms. States also limit the amount of cannabis an individual can purchase in a day or possess at a given time.
• Prescription drug monitoring programs (PDMPs) – PDMPs are electronic databases designed to track the prescribing and dispensing of controlled prescription drugs. Maintained at the state level, PDMPs aim to identify and prevent prescription drug diversion such as forgery, doctor shopping (visiting multiple providers to obtain prescriptions), and improper prescribing or dispensing practices. Evidence demonstrates that providing prescribers and pharmacists with access to this information helps reduce the overprescribing of opioids, particularly for individuals at risk of developing substance use disorders (SUD).
  Most PDMPs are managed by the state's Board of Pharmacy. Each state establishes regulations determining which drugs are monitored and who can access the data. Typically, authorized users include law enforcement representatives, healthcare professionals, state Medicaid programs, medical examiners or coroners, and some research organizations. Most states permit practitioners and pharmacists to access PDMP data to review a patient's prescription history. PDMP data can also supplement surveillance efforts by identifying emerging trends in prescription drug use.
  Since these systems are managed at the state level, local agencies may have limited input into their design or accessibility. PDMP data are not always available in real time and can be difficult to use effectively. In state border areas, patients may evade detection by filling prescriptions in neighboring states where prescribers and pharmacists do not have access to interstate data. To address this, states have increased data-sharing through the National Association of Boards of Pharmacy's InterConnect® program, which facilitates secure prescription data transfer between states.
• Regulating Sellers and Outlet Density – Licensing and zoning can help limit the number and location of retailers, which can reduce the overall frequency of sales. Licenses are regulated by state, and requirements vary but often include a background check, licensing fee, and age restrictions for sellers. Some states limit the number of cannabis and liquor licenses available and hold lotteries to distribute licenses. A positive association exists between alcohol outlet density and excessive alcohol consumption and alcohol-related harms, such as violence, crime, and injuries. The Community Preventive Services Task Force (CPSTF) recommends regulating alcohol outlet density as an effective strategy for reducing harms from excessive alcohol consumption.
• Regulating Prescribers – Many states have enacted regulations to limit prescription drug use within a period of time and ensure patient safety. For example, states have laws that limit both the dosage and duration of supply for prescription opioids, also known as painkillers.

Resources to Learn More

Prescription Drug Monitoring Program Training and Technical Assistance Center
Website
Provides PDMP reports, recommendations, and trainings. Includes a database of PDMP profiles for each state, with information on which drugs are monitored, data collection frequency, legislation updates, and other relevant information.
Organization(s): Prescription Drug Monitoring Program Training and Technical Assistance Center

Prescription Drug Monitoring Programs
Website
Offers guidance on using PDMPs to improve opioid prescribing practices, enhance patient safety, and support informed decision-making by reviewing controlled substance prescriptions and coordinating care.
Organization(s): Centers for Disease Control and Prevention