Effect of Florida’s Prescription Drug Monitoring Program and Pill Mill Laws on Opioid Prescribing and Use

Abstract

Program (PDMP) and pill mill laws are among the principal means states use to reduce prescription drug abuse and diversion, yet little high-quality evidence exists regarding their effect. OBJECTIVE To quantify the effect of Florida's PDMP and pill mill laws on overall and high-risk opioid prescribing and use. DESIGN, SETTING, AND PARTICIPANTS We applied comparative interrupted time-series analyses to IMS Health LifeLink LRx data to characterize the effect of PDMP and pill mill law implementation on a closed cohort of prescribers, retail pharmacies, and patients from July 2010 through September 2012 in Florida (intervention state) compared with Georgia (control state). We conducted sensitivity analyses, including varying length of observation and modifying requirements for continuous observation of individuals throughout the study period. MAIN OUTCOMES AND MEASURES Total opioid volume, mean morphine milligram equivalent (MME) per transaction, mean days' supply per transaction, and total number of opioid prescriptions dispensed. Analyses were conducted per prescriber and per patient, in aggregate and after stratifying by volume of baseline opioid prescribing for prescribers and use for patients. RESULTS From July 2010 through September 2012, a cohort of 2.6 million patients, 431 890 prescribers, and 2829 pharmacies was associated with approximately 480 million prescriptions in Florida and Georgia, 7.7% of which were for opioids. Total monthly opioid volume, MME per transaction, days' supply, and prescriptions dispensed were higher in Florida than Georgia before implementation. Florida's laws were associated with statistically significant declines in opioid volume (2.5 kg/mo, P < .05; equivalent to approximately 500 000 5-mg tablets of hydrocodone bitartrate per month) and MME per transaction (0.45 mg/mo, P < .05), without any change in days' supply. Twelve months after implementation, the policies were associated with approximately a 1.4% decrease in opioid prescriptions, 2.5% decrease in opioid volume, and 5.6% decrease in MME per transaction. Reductions were limited to prescribers and patients with the highest baseline opioid prescribing and use. Sensitivity analyses, varying time windows, and enrollment criteria supported the main results. CONCLUSIONS AND RELEVANCE Florida's PDMP and pill mill laws were associated with modest decreases in opioid prescribing and use. Decreases were greatest among prescribers and patients with the highest baseline opioid prescribing and use.

Commentary on Pardo (2017) and Moyo et al. (2017): Much still unknown about prescription drug monitoring programs

“…Consistent with previous research, changes were found to vary dramatically between states and subgroups, and were limited largely to Schedule II opioids [3][4][5][6]. In a country where opioid prescribing nearly quadrupled from 1999 to 2008, it seems likely that much larger and more broad-based declines will be necessary to move the needle significantly on OA-related overdose [7].…”

Change in Prescription Habits After Federal Rescheduling of Hydrocodone Combination Products

“…Th ough prescription drug abuse is an undeniable problem in the United States, this study demonstrates several shortcomings of the federal rescheduling of hydrocodone combination products. While several other state and FDA regulations show promise, there is little published data regarding the eff ectiveness of specifi c drug policies ( 4 ). With approximately 44 deaths due to prescription drug overdose each day, increased research and a multifaceted approach are essential in combating the prescription drug abuse epidemic.…”

Increasing Access to Medication-Assisted Treatment for Opioid Use Disorders: Estimating Costs, Supply, and the Effects of Insurance Expansions

“…Florida's legislative actions in 2010 through 2012, from crackdown on pain clinics to the establishment of its Prescription Drug Monitoring Program (which began operating in 2011 and included buprenorphine, schedule III drug), may confound the results of the analysis if this state is included. Some studies have shown that these policies had a significant effect on reducing opioid prescriptions, hospitalizations and deaths in Florida during the years of MHPAEA implementation (Rutkow et al, 2015;Kennedy-Hendricks et al, 2015). (2) As a consequence of the previously mentioned supply-side policies, drug overdose deaths and total standard doses of buprenorphine per month per 100,000 inhabitants in Florida declined compared to other states in the sample, thus a comparison with the rest of the states affected by MHPAEA might not be adequate.…”

“…with OUD with respect to other states in America, and thus had a higher demand for MAT than others Rutkow et al, 2015;Kennedy-Hendricks et al, 2015). However, as long as these differences between states do not vary significantly over the period prior to MHPAEA's IFR implementation, a DDD analysis can still provide an estimate of the effect of this policy on buprenorphine access.…”