Impact of Florida's prescription drug monitoring program and pill mill law on high‐risk patients: A comparative interrupted time series analysis

Chang, Hsien Yen; Murimi, Irene B.; Faul, Margaret M.; Rutkow, Lainie; Alexander, G. Caleb

doi:10.1002/pds.4404

Cited by 30 publications

(30 citation statements)

References 44 publications

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“…Targeted interventions typically focus on providers who prescribe opioids above a specified threshold. A common targeted intervention is the creation of “pill mill” laws, which typically require documentation of medical examinations and follow-up visits before and after the prescribing of opioids, mandatory registration of clinics with the state, or physician ownership of pain clinics 2122232425…”

Section: Introductionmentioning

confidence: 99%

Opioid prescribing patterns among medical providers in the United States, 2003-17: retrospective, observational study

Kiang

Humphreys

Cullen

et al. 2020

BMJ

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ObjectiveTo examine the distribution and patterns of opioid prescribing in the United States.DesignRetrospective, observational study.SettingNational private insurer covering all 50 US states and Washington DC.ParticipantsAn annual average of 669 495 providers prescribing 8.9 million opioid prescriptions to 3.9 million patients from 2003 through 2017.Main outcome measuresStandardized doses of opioids in morphine milligram equivalents (MMEs) and number of opioid prescriptions.ResultsIn 2017, the top 1% of providers accounted for 49% of all opioid doses and 27% of all opioid prescriptions. In absolute terms, the top 1% of providers prescribed an average of 748 000 MMEs—nearly 1000 times more than the middle 1%. At least half of all providers in the top 1% in one year were also in the top 1% in adjacent years. More than two fifths of all prescriptions written by the top 1% of providers were for more than 50 MMEs a day and over four fifths were for longer than seven days. In contrast, prescriptions written by the bottom 99% of providers were below these thresholds, with 86% of prescriptions for less than 50 MMEs a day and 71% for fewer than seven days. Providers prescribing high amounts of opioids and patients receiving high amounts of opioids persisted over time, with over half of both appearing in adjacent years.ConclusionsMost prescriptions written by the majority of providers are under the recommended thresholds, suggesting that most US providers are careful in their prescribing. Interventions focusing on this group of providers are unlikely to effect beneficial change and could induce unnecessary burden. A large proportion of providers have established relationships with their patients over multiple years. Interventions to reduce inappropriate opioid prescribing should be focused on improving patient care, management of patients with complex pain, and reducing comorbidities rather than seeking to enforce a threshold for prescribing.

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Section: Introductionmentioning

confidence: 99%

Opioid prescribing patterns among medical providers in the United States, 2003-17: retrospective, observational study

Kiang

Humphreys

Cullen

et al. 2020

BMJ

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“…In addition, several evaluations of the 2010‐2011 Florida policies targeting opioid misuse observed PDMPs and pain management clinic policies together were associated with reductions in opioids prescribed. Florida introduced these policies in quick succession (see section on combined effects of multiple policy interventions) . Given that the initial Florida PDMP implemented on September 1, 2011, was relatively weak, since it did not contain critical provisions, such as registration or use mandates, it is challenging to attribute the entirety of the change in opioid prescribing to the PDMP, and not the combined or singular effect of the pain clinic law and other policies implemented during the same period…”

Section: Resultsmentioning

confidence: 99%

“…Three rigorous evaluations suggest that the combined 2010‐2011 Florida interventions were associated with reductions in opioids prescribed, with effects concentrated among the highest baseline opioid users and prescribers . Surratt and colleagues (2014) observed a decline in diversion rates following implementation of the Florida policy interventions.…”

Section: Resultsmentioning

confidence: 99%

The Association of State Opioid Misuse Prevention Policies With Patient‐ and Provider‐Related Outcomes: A Scoping Review

2019

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This scoping review reveals a growing literature on the effects of certain state opioid misuse prevention policies, but persistent gaps in evidence on other prevalent state policies remain. Policymakers interested in reducing the volume and dosage of opioids prescribed and dispensed can consider adopting robust prescription drug monitoring programs with mandatory access provisions and drug supply management policies, such as prior authorization policies for high‐risk prescription opioids. Further research should concentrate on potential unintended consequences of opioid misuse prevention policies, differential policy effects across populations, interventions that have not received sufficient evaluation (eg, Good Samaritan laws, naloxone access laws), and patient‐related outcomes. Context In the midst of an opioid crisis in the United States, an influx of state opioid misuse prevention policies has provided new opportunities to generate evidence of policy effectiveness that can inform policy decisions. We conducted a scoping review to synthesize the available evidence on the effectiveness of US state interventions to improve patient and provider outcomes related to opioid misuse and addiction. Methods We searched six online databases to identify evaluations of state opioid policies. Eligible studies examined legislative and administrative policy interventions that evaluated (a) prescribing and dispensing, (b) patient behavior, or (c) patient health. Findings Seventy‐one articles met our inclusion criteria, including 41 studies published between 2016 and 2018. These articles evaluated nine types of state policies targeting opioid misuse. While prescription drug monitoring programs (PDMPs) have received considerable attention in the literature, far fewer studies addressed other types of state policy. Overall, evidence quality is very low for the majority of policies due to a small number of evaluations. Of interventions that have been the subject of considerable research, promising means of reducing the volume and dosages of opioids prescribed and dispensed include drug supply management policies and robust PDMPs. Due to low study number and quality, evidence is insufficient to draw conclusions regarding interventions targeting patient behavior and health outcomes, including naloxone access laws and Good Samaritan laws. Conclusions Recent research has improved the evidence base on several state interventions targeting opioid misuse. Specifically, moderate evidence suggests that drug supply management policies and robust PDMPs reduce opioid prescribing. Despite the increase in rigorous evaluations, evidence remains limited for the majority of policies, particularly those targeting patient health–related outcomes.

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“…Next, we used the 2012 medical and pharmacy claims to define three patient groups at elevated risks of adverse events from prescription opioids. We defined ‘chronic users’ as those consuming more than 100 MMEs per day for more than 90 consecutive days [ 23 , 24 ]. Chronic opioid use is related to higher medical utilization and a greater likelihood of overdose death [ 20 , 21 , 25 ].…”

Section: Methodsmentioning

confidence: 99%

“…Chronic opioid use is related to higher medical utilization and a greater likelihood of overdose death [ 20 , 21 , 25 ]. We defined ‘concomitant users’ as patients filling more than 30-days of concomitant opioids and benzodiazepines [ 23 , 24 ]. Benzodiazepines are associated with approximately one-third of overdose deaths involving prescription opioids [ 26 ] and the odds of dying by overdose is four-fold higher among veterans with current benzodiazepine prescriptions [ 27 ].…”

Section: Methodsmentioning

confidence: 99%

Healthcare costs and utilization associated with high-risk prescription opioid use: a retrospective cohort study

Chang

Kharrazi

Bodycombe

et al. 2018

BMC Med

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BackgroundPrevious studies on high-risk opioid use have only focused on patients diagnosed with an opioid disorder. This study evaluates the impact of various high-risk prescription opioid use groups on healthcare costs and utilization.MethodsThis is a retrospective cohort study using QuintilesIMS health plan claims with independent variables from 2012 and outcomes from 2013. We included a population-based sample of 191,405 non-elderly adults with known sex, one or more opioid prescriptions, and continuous enrollment in 2012 and 2013. Three high-risk opioid use groups were identified in 2012 as (1) persons with 100+ morphine milligram equivalents per day for 90+ consecutive days (chronic users); (2) persons with 30+ days of concomitant opioid and benzodiazepine use (concomitant users); and (3) individuals diagnosed with an opioid use disorder. The length of time that a person had been characterized as a high-risk user was measured. Three healthcare costs (total, medical, and pharmacy costs) and four binary utilization indicators (the top 5% total cost users, the top 5% pharmacy cost users, any hospitalization, and any emergency department visit) derived from 2013 were outcomes. We applied a generalized linear model (GLM) with a log-link function and gamma distribution for costs while logistic regression was employed for utilization indicators. We also adopted propensity score weighting to control for the baseline differences between high-risk and non-high-risk opioid users.ResultsOf individuals with one or more opioid prescription, 1.45% were chronic users, 4.81% were concomitant users, and 0.94% were diagnosed as having an opioid use disorder. After adjustment and propensity score weighting, chronic users had statistically significant higher prospective total (40%), medical (3%), and pharmacy (172%) costs. The increases in total, medical, and pharmacy costs associated with concomitant users were 13%, 7%, and 41%, and 28%, 21% and 63% for users with a diagnosed opioid use disorder. Both total and pharmacy costs increased with the length of time characterized as high-risk users, with the increase being statistically significant. Only concomitant users were associated with a higher odds of hospitalization or emergency department use.ConclusionsIndividuals with high-risk prescription opioid use have significantly higher healthcare costs and utilization than their counterparts, especially those with chronic high-dose opioid use.

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Impact of Florida's prescription drug monitoring program and pill mill law on high‐risk patients: A comparative interrupted time series analysis

Abstract: Compared with Georgia, Florida's prescription drug monitoring program and pill mill law were associated with large relative reductions in prescription opioid utilization among high-risk patients.

Cited by 30 publications

References 44 publications

Opioid prescribing patterns among medical providers in the United States, 2003-17: retrospective, observational study

Opioid prescribing patterns among medical providers in the United States, 2003-17: retrospective, observational study

The Association of State Opioid Misuse Prevention Policies With Patient‐ and Provider‐Related Outcomes: A Scoping Review

Healthcare costs and utilization associated with high-risk prescription opioid use: a retrospective cohort study

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