Prescription Opioid Usage and Abuse Relationships: An Evaluation of State Prescription Drug Monitoring Program Efficacy

Reisman, R. M.; Shenoy, Pareen J.; Atherly, Adam; Flowers, Christopher R.

doi:10.4137/sart.s2345

Cited by 69 publications

(65 citation statements)

References 4 publications

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“…In addition, the effectiveness of PMPs across states is currently debated in the literature, with assessments of PMP effectiveness frequently reporting weak or inconclusive results. 32–34 …”

Section: Discussionmentioning

confidence: 99%

Geographic Variation of Chronic Opioid Use in Fibromyalgia

Painter

Crofford

Talbert

2013

Clinical Therapeutics

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Background Opioid use for the treatment of chronic nonmalignant pain has increased drastically over the past decade. Although no evidence of efficacy exists supporting the treatment of fibromyalgia (FM) with chronic opioid therapy, a large number of patients are receiving this therapy. Geographic variation in the use of opioids has been demonstrated in the past, but there are no studies examining variation of chronic opioid use. Objective This study examines both the extent of geographic variation and the factors associated with variation across states of chronic opioid use among patients with FM. Methods Using a large, nationally representative dataset of commercially insured individuals, the following characteristics were examined: sex, disease prevalence, physician prevalence, illicit drug use, and the prescence of a prescription monitoring program. Other contextual and structural characteristics were also assessed. Results The analysis included 245,758 patients with FM; 11.3% received chronic opioid therapy during the study period. There was a 5-fold difference between the states with the lowest rate of use (∼4%) and those with the highest (∼20%). The weighted %CV was 36.2%. Percent female and previous illicit opioid use rates were associated with higher rates of chronic opioid use, and FM prevalence and physician prevalence were associated with lower rates. The presence of a prescription monitoring program was not significantly correlated. Conclusions Geographic variation in chronic opioid use among patients with FM exists at rates similar to those seen in other studies examining opioid use. This large level of geographic variation suggests that the prescribing decision is not based solely on physician-patient interaction but also on contextual and structural factors at the state level. The level of physician and condition prevalence suggest that information dissemination and peer-to-peer interaction may play a key role in adopting evidence-based medicine for the treatment of patients suffering from FM and related conditions. Level of diagnosis prevalence as a predictor of evidence-based practice has not been reported in the literature and is an important contribution to research on geographic variation.

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Section: Discussionmentioning

confidence: 99%

Geographic Variation of Chronic Opioid Use in Fibromyalgia

Painter

Crofford

Talbert

2013

Clinical Therapeutics

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“…This study contributes to a nascent literature that explores the impact of electronic PMPs 14,20,23 by examining policy change effects for California’s CURES program, the oldest and largest PMP. Requiring a security form in 2005, replacing its historical triplicate prescription form, had variable effects on the prescribing of each study opioid.…”

Section: Discussionmentioning

confidence: 99%

Time Series Analysis of California’s Prescription Monitoring Program: Impact on Prescribing and Multiple Provider Episodes

Gilson

Fishman

Wilsey

et al. 2012

The Journal of Pain

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Prescription monitoring programs (PMPs) are designed to reduce medication diversion by identifying individuals obtaining the same medication from multiple providers (termed multiple provider episodes [MPEs]). This study determined whether recent changes to California’s PMP influenced: 1) the extent that practitioners issue prescriptions for a variety of Schedule II opioids; and 2) the incidence of MPEs involving these opioids. Intervention time series of California’s PMP data was used to determine the effect of requiring practitioners to transition from using triplicate prescription forms for Schedule II medications to security forms for all controlled substances. Outcome measures included changes in number of prescriptions issued for Schedule II long-acting or short-acting (SA) opioids and the MPEs involving these medications. Requiring a security form was associated with a sustained prescribing increase for SA hydromorphone, meperidine, and SA oxycodone; no prescribing changes were found for SA fentanyl, methadone, and SA morphine, or for any long-acting opioids. The same policy change, however, increased MPEs involving all opioids. Further effort is required to determine how California’s PMP can continue to ensure availability of prescription opioids for medical use while better mitigating their diversion. Perspective Statistical model-building was used to evaluate the influence of changes to California’s prescription monitoring program. The extent that practitioners prescribe Schedule II opioids and the incidence of people receiving prescriptions from multiple providers were measured. Such research illustrates the viability of evaluating drug control program impact on prescribing practice and potential diversion behaviors.

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“…Although we (Daubresse et al, 2015) and others (Ringwait et al, 2015; Hackman et al, 2014; Surratt et al, 2014 and Reisman et al, 2009) have used quasi-experimental methods to evaluate the effect of Prescription Drug Monitoring Programs (PDMPs), to our knowledge, no studies have empirically evaluated the unique effect of a state’s implementation of a pill mill law in absence of a concurrent PDMP. This distinction is important because these policies differ in meaningful ways.…”

Section: Introductionmentioning

confidence: 99%

Effect of a “pill mill” law on opioid prescribing and utilization: The case of Texas

Lyapustina

Rutkow

Chang

et al. 2016

Drug and Alcohol Dependence

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Background States have attempted to reduce prescription opioid abuse through strengthening the regulation of pain management clinics; however, the effect of such measures remains unclear. We quantified the impact of Texas’s September 2010 “pill mill” law on opioid prescribing and utilization. Methods We used the IMS Health LRx LifeLink database to examine anonymized, patient-level pharmacy claims for a closed cohort of individuals filling prescription opioids in Texas between September 2009 and August 2011. Our primary outcomes were derived at a monthly level and included: (1) average morphine equivalent dose (MED) per transaction; (2) aggregate opioid volume; (3) number of opioid prescriptions; and (4) quantity of opioid pills dispensed. We compared observed values with the counterfactual, which we estimated from pre-intervention levels and trends. Results Texas’s pill mill law was associated with declines in average MED per transaction (−0.57 mg/month, 95% confidence interval [CI] −1.09, −0.057), monthly opioid volume (−9.99 kg/month, CI −12.86, −7.11), monthly number of opioid prescriptions (−12,200 prescriptions/month, CI −15,300, −9,150) and monthly quantity of opioid pills dispensed (−714,000 pills/month, CI −877,000, −550,000). These reductions reflected decreases of 8.1–24.3% across the outcomes at one year compared with the counterfactual, and they were concentrated among prescribers and patients with the highest opioid prescribing and utilization at baseline. Conclusions Following the implementation of Texas’s 2010 pill mill law, there were clinically significant reductions in opioid dose, volume, prescriptions and pills dispensed within the state, which were limited to individuals with higher levels of baseline opioid prescribing and utilization.

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Prescription Opioid Usage and Abuse Relationships: An Evaluation of State Prescription Drug Monitoring Program Efficacy

Cited by 69 publications

References 4 publications

Geographic Variation of Chronic Opioid Use in Fibromyalgia

Geographic Variation of Chronic Opioid Use in Fibromyalgia

Time Series Analysis of California’s Prescription Monitoring Program: Impact on Prescribing and Multiple Provider Episodes

Effect of a “pill mill” law on opioid prescribing and utilization: The case of Texas

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