Zhang H, Kilaru AS, Meisel ZF, et al. - In the emergency department (ED), opioid analgesics remain first-line therapies for managing acute pain in patients with sickle cell disease (SCD) or cancer with bone metastasis. Access to opioids for these patients may inadvertently be limited by 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). Researchers herein examined how implementation of PDMP mandates are associated with changes in opioids dispensed to these patients following ED encounters. Using 2011-2017 Health Care Cost Institute (HCCI) claims data, that covered 27% of commercially insured individuals across the US in 2017, they retrieved data of eligible patients who resided in 1 of 29 states with active prescriber online access to a PDMP. Of the 29 included states, 17 had implementation of a noncomprehensive mandate by the end of 2017, of which 7 transitioned from non comprehensive to comprehensive. Findings revealed correlation of comprehensive PDMP mandates with substantial decreases in opioids prescribed to cases with SCD or cancer with bone metastasis after ED encounters. Potential explanations include reduced prescribing due to clinician concerns regarding misuse or diversion, elevated administrative burden, and prescriber perception of liability linked with opioid prescribing.