Prescription Drug Monitoring and Child Maltreatment in the United States, 2004-2018.

Objective To test whether a policy approach aimed at reducing prescription drug misuse, specifically, state monitoring of controlled substance prescriptions—Prescription Drug Monitoring Programs (PDMPs)—were associated with changes in Child Protective Services-reported maltreatment prevalence. Study design Using a difference-in-differences design and maltreatment data (2004-2018) from 50 states and the District of Columbia, we compared the prevalence of total maltreatment incidents and total victims, in states with and without PDMPs, before and after implementation. Exploratory analyses further examined models disaggregated by maltreatment type (neglect, physical abuse, sexual abuse, psychological abuse) and among different racial/ethnic groups. Quasi-Poisson models included state-level covariates, state- and year-fixed effects, and cluster-robust standard errors. Results Difference-in-differences models identified greater reductions in PDMP states relative to controls (total PR: 0.87 [95% Confidence Interval (CI): 0.80, 0.940]; victimization PR: 0.92 [CI: 0.85, 0.98) over the observation period. Reductions appeared to be driven by changes in neglect (PR: 0.87 [CI: 0.80, 0.93]) and physical abuse (PR: 0.78 [CI: 0.71-0.87]) incidents, and may have been especially salient for American Indian/Alaskan Native children (PR: 0.78 [CI: 0.65, 0.94]). Conclusions We found evidence supporting an association between prescription drug monitoring and reduced maltreatment prevalence at the state-level. Policies aimed at restricting the prescribing and dispensing of controlled substances, may have indirect implications for child welfare.