Assessing the impact of Indiana legislation on opioid-based doctor shopping among Medicaid-enrolled pregnant women: a regression analysis

Abstract

Background States have passed various legislative acts in an attempt to reduce opioid prescribing and corresponding doctor shopping, including prescription drug monitoring programs. This study seeks to determine the association between two state-based interventions enacted in Indiana and the level of doctor shopping among Medicaid-enrolled pregnant women. Methods Indiana Medicaid claims data over the period of January 2014 to March 2019 were used in a regression model to determine the longitudinal change in percentage of pregnant women engaged in doctor shopping based on passage of Indiana Administrative Code Title 884 in 2014 and Public Law 194 in 2018. The primary reasons for prescribing were also identified. Results There were 37,451 women that had both pregnancy and prescription opioid claims over the time horizon. Of these, 2130 women met the criteria for doctor shopping. Doctor shopping continued to increase over the time between the passage of the two interventions but decreased after passage of Public Law 194. Conclusion The decrease in doctor shopping among Medicaid-enrolled pregnant women after passage of Public Law 194 points to the importance of addressing this issue across a broad set of healthcare professionals including nurse practitioners and physician assistants. It is also possible that the potential punitive component in the Law for non-compliance played a role.

Mapping the research addressing prescription drug monitoring programs: A scoping review

“…Overall, half of the studies involved patients [9,18,22–24,26,27,32,34,36–38,41–43,45,46,48,50,53,54,59,62,63,65,66,71,73,75,77–80,84–86,88,90,93,95,97,98,100,101,104,105,108–110,115–118,121,123,125,130,131,134,140,144,146,147,149,151,152,154–156,158,159,161,163,165,167] and 47% included health‐care providers [11,19,20,25,29,30,33,35,37,39,40,43,44,49,51,54–61,67–69,71,72,74,76,80–83,87,91,93,94,96,102,103,106,111–114,119,120,122,124,125,127,128,130,132,133,136–139,141,143,145,147,148,150,153,157,160,162,165]. Some studies included both patient and provider populations [36, 37, 54, 59, 80, 93, 130, 147, 166].…”

“…Thirty‐two studies examined non‐opioid medications (21%), with half of these focused on benzodiazepines [9,22,24,38,40,46,52,54,85,86,132,144,146,152,159,160]. Other studies examined diversion, prescription shopping and illicit drug use (23%), unintended consequences of PDMPs (15%) [5,18,19,32–34,36,39,41,42,47,48,53,62,73,75,78,95,99,105,123,131,138,164], and opioid dispensing (13%). Thirty‐nine implementation studies focused on attitudes and use of PDMPs (25%), followed by barriers (18%) and facilitators (14%) to use [11,20,30,37,39,40,49,58,60,65,68,72,74,76,82,87,90,91,93,94,96,100,102,107,113,122–125,128,135–137,139,143,146,159,162].…”

“…The extracted data from the included studies were then classified into main conceptual categories and summarised to align with the scoping review objective and research questions. The data extraction results are presented in Tables S1 and S2 [18–166], Supporting Information.…”

“…A very small number of studies (1%) examined PDMP use and association with doctor shopping, neonatal abstinence syndrome and drug trafficking as the major focus area [33,75,101].…”

“…A total of 94 of the 153 retrieved studies were published between 2018 and 2020, with 16 studies published in 2021 [11,37,40,45,60,67,73,75,78,94,105,141,[150][151][152]154]. The majority of studies originated from the USA, with only four Canadian studies [11,107,145,158] and one Malaysian study included in this scoping review [21].…”