Association of State Opioid Duration Limits With Postoperative Opioid Prescribing

Agarwal, Sunil; Bryan, J. Daniel; Hu, Hsou Mei; Lee, Jay S.; Chua, Kao-Ping; Haffajee, Rebecca L.; Brummett, Chad M.; Englesbe, Michael J.; Waljee, Jennifer F.

doi:10.1001/jamanetworkopen.2019.18361

Cited by 58 publications

(66 citation statements)

References 20 publications

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“…In contrast to other policy efforts which have undergone study, SB 273 did not have an exception for “professional judgement,” which allows prescribers to override the limits if they feel it is medically required. Agarwal and colleagues [ 33 ] have previously postulated that exceptions for “professional judgement” may account for the lack of effect, or minimal effect, of similar laws in other states; concordantly, we found an association in the absence of such an exception within this state specific legislation, which may support that assertion. Greene and colleagues [ 34 ] have similarly noted anecdotal evidence that physicians were “getting around” state level prescription limits by writing and back-dating multiple prescriptions, however our data does not support that theory in West Virginia given the continuing decrease in overall number of prescriptions.…”

Section: Discussionsupporting

confidence: 89%

Assessing the impact of a restrictive opioid prescribing law in West Virginia

Sedney

Khodaverdi²,

Pollini

et al. 2021

Subst Abuse Treat Prev Policy

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Background The Opioid Reduction Act (SB 273) took effect in West Virginia in June 2018. This legislation limited ongoing chronic opioid prescriptions to 30 days’ supply, and first-time opioid prescriptions to 7 days’ supply for surgeons and 3 days’ for emergency rooms and dentists. The purpose of this study was to determine the effect of this legislation on reducing opioid prescriptions in West Virginia, with the goal of informing future similar policy efforts. Methods Data were requested from the state Prescription Drug Monitoring Program (PDMP) including overall number of opioid prescriptions, number of first-time opioid prescriptions, average daily morphine milligram equivalents (MME) and prescription duration (expressed as “days’ supply”) given to adults during the 64 week time periods before and after legislation enactment. Statistical analysis was done utilizing an autoregressive integrated moving average (ARIMA) interrupted time series analysis to assess impact of both legislation announcement and enactment while controlling secular trends and considering autocorrelation trends. Benzodiazepine prescriptions were utilized as a control. Results Our analysis demonstrates a significant decrease in overall state opioid prescribing as well as a small change in average daily MME associated with the date of the legislation’s enactment when considering serial correlation in the time series and accounting for pre-intervention trends. There was no such association found with benzodiazepine prescriptions. Conclusion Results of the current study suggest that SB 273 was associated with an average 22.1% decrease of overall opioid prescriptions and a small change in average daily MME relative to the date of legislative implementation in West Virginia. There was, however, no association of the legislation on first-time opioid prescriptions or days’ supply of opioid medication, and all variables were trending downward prior to implementation of SB 273. The control demonstrated no relationship to the law.

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Section: Discussionsupporting

confidence: 89%

Assessing the impact of a restrictive opioid prescribing law in West Virginia

Sedney

Khodaverdi²,

Pollini

et al. 2021

Subst Abuse Treat Prev Policy

View full text Add to dashboard Cite

show abstract

“…In contrast to other policy efforts which have undergone study, West Virginia SB 273 did not have an exception for "professional judgement," which allows prescribers to override the limits if they feel it is medically required. Agarwal and colleagues [33] have previously postulated that exceptions for "professional judgement" may account for the lack of effect, or minimal effect, of similar laws in other states; concordantly, we found an association in the absence of such an exception within this state specific legislation, which may support that assertion. Greene and colleagues [34] have similarly noted anecdotal evidence that physicians were "getting around" state level prescription limits by writing and back-dating multiple prescriptions, however our data does not support that theory in West Virginia given the continuing decrease in overall number of prescriptions.…”

Section: Discussionsupporting

confidence: 88%

Assessing The Impact of A Restrictive Opioid Prescribing Law in West Virginia

Sedney

Khodaverdi

Pollini

et al. 2020

Preprint

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Background: The Opioid Reduction Act (SB 273) took effect in West Virginia in June 2018. This legislation limited ongoing chronic opioid prescriptions to 30 days’ supply, and first-time opioid prescriptions to 7 days’ supply for surgeons and 3 days’ for emergency rooms and dentists. The purpose of this study was to determine the effect of this legislation on reducing opioid prescriptions in West Virginia, with the goal of informing future similar policy efforts. Methods: Data were requested from the state Prescription Drug Monitoring Program (PDMP) including overall number of opioid prescriptions, number of first-time opioid prescriptions, average daily morphine milligram equivalents (MME) and prescription duration (expressed as “day’s supply”) given to adults during the 64 week time periods before and after legislation enactment. Statistical analysis was done utilizing an autoregressive integrated moving average (ARIMA) interrupted time series analysis to assess impact of both legislation announcement and enactment while controlling secular trends and considering autocorrelation trends. Benzodiazepine prescriptions were utilized as a control.Results: Our analysis demonstrates a statistically significant decrease in overall state opioid prescribing as well as average daily MME associated with the date of the legislation’s enactment when considering serial correlation in the time series and accounting for pre-intervention trends. There was no such association found with benzodiazepine prescriptions.Conclusion: Results of the current study suggest that SB 273 was associated with an average 22.1% decrease of overall opioid prescriptions and a small overall decrease of average daily MME relative to the date of legislative implementation in West Virginia. There was, however, no association of the legislation on first-time opioid prescriptions or days’ supply of opioid medication, and all variables were trending downward prior to implementation of SB 273. The control demonstrated no relationship to the law.

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“…18,23,47 Furthermore, mandates enforcing required checks of statewide prescription monitoring programs before prescribing an opiate or legislation aimed at combatting excessive prescriptions through limits on OMEs or days prescribed may be further driving a reduction in use. 2,43,47,48 While this study offers many interesting findings, there are multiple limitations, and readers should interpret the results of this study with these in mind. First, as is the case with an analysis of any large claims database, we were reliant on accurate coding for the capture of all preoperative and postoperative events with International Classification of Diseases and CPT codes.…”

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Preoperative Opioid Use Is a Risk Factor for Revision Surgery, Complications, and Increased Resource Utilization After Arthroscopic Rotator Cuff Repair

et al. 2020

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Background: Studies have shown preoperative opioid use to influence outcomes after various surgical procedures. Researchers have not assessed this relationship after rotator cuff repair (RCR). Hypothesis/Purpose: The purpose of this study was to assess the relationship between preoperative opioid use and outcomes after arthroscopic RCR. We hypothesized that patients prescribed higher daily averages of preoperative oral morphine equivalents (OMEs) would show increased rates of 90-day complications and 3-year revision surgery. Study Design: Cohort study; Level of evidence, 3. Methods: The MarketScan claims database was utilized to identify patients who underwent arthroscopic RCR between 2009 and 2018. We used preoperative opioid use status to divide patients into groups based on the average daily OMEs consumed in the 6 months before surgery: opioid-naïve, <1, 1-<5, 5-<10, and ≥10 OMEs per day. We retrieved 90-day complication and 3-year revision surgery rates. Opioid use groups were then compared with binomial logistic regression and generalized linear models. Results: We identified 214,283 patients. Of those patients, 50.7% did not receive any preoperative opioids, while 7.7%, 26.8%, 6.3%, and 8.6% received <1, 1-<5, 5-<10, and ≥10 OMEs per day over a 6-month time period, respectively. Complications increased with increasing preoperative OMEs. Multivariate analysis revealed that any patient using ≥1 OME per day had increased rates of 3-year revision surgery, reoperations, and infections. Specifically, patients averaging ≥10 OMEs per day showed a 103% (odds ratio, 2.03 [95% CI, 1.62-2.54]; P < .001) increase in the odds of revision surgery compared with opioid-naïve patients. Rates of hospital admissions and postoperative emergency department encounters were higher in all opioid use groups. Adjusted differences in 6-month preoperative and 3-month postoperative health care costs were seen in the opioid use groups compared with opioid-naïve patients, ranging from US$1307 to US$5820 ( P < .001). Conclusion: Preoperative opioid use was a risk factor for complications and revision surgery after arthroscopic RCR. We also observed a dose-dependent response between opioid use and postoperative complications.

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Association of State Opioid Duration Limits With Postoperative Opioid Prescribing

Cited by 58 publications

References 20 publications

Assessing the impact of a restrictive opioid prescribing law in West Virginia

Assessing the impact of a restrictive opioid prescribing law in West Virginia

Assessing The Impact of A Restrictive Opioid Prescribing Law in West Virginia

Preoperative Opioid Use Is a Risk Factor for Revision Surgery, Complications, and Increased Resource Utilization After Arthroscopic Rotator Cuff Repair

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