Impact of prescription drug monitoring programs and pill mill laws on high-risk opioid prescribers: A comparative interrupted time series analysis

Abstract

Background Prescription drug monitoring programs (PDMPs) and pill mill laws were implemented to reduce opioid-related injuries/deaths. We evaluated their effects on high-risk prescribers in Florida. Methods We used IMS Health's LRx Lifelink database between July 2010 and September 2012 to identify opioid-prescribing prescribers in Florida (intervention state, N: 38,465) and Georgia (control state, N: 18,566). The pre-intervention, intervention, and post-intervention periods were: July 2010–June 2011, July 2011–September 2011, and October 2011–September 2012. High-risk prescribers were those in the top 5th percentile of opioid volume during four consecutive calendar quarters. We applied comparative interrupted time series models to evaluate policy effects on clinical practices and monthly prescribing measures for low-risk/high-risk prescribers. Results We identified 1526 (4.0%) high-risk prescribers in Florida, accounting for 67% of total opioid volume and 40% of total opioid prescriptions. Relative to their lower-risk counterparts, they wrote sixteen times more monthly opioid prescriptions (79 vs. 5, p < 0.01), and had more prescription-filling patients receiving opioids (47% vs. 19%, p < 0.01). Following policy implementation, Florida's high-risk providers experienced large relative reductions in opioid patients and opioid prescriptions (−536 patients/month, 95% confidence intervals [CI] −829 to −243; −847 prescriptions/month, CI −1498 to −197), morphine equivalent dose (−0.88 mg/month, CI −1.13 to −0.62), and total opioid volume (−3.88 kg/month, CI −5.14 to −2.62). Low-risk providers did not experience statistically significantly relative reductions, nor did policy implementation affect the status of being high- vs. low- risk prescribers. Conclusions High-risk prescribers are disproportionately responsive to state policies. However, opioidsprescribing remains highly concentrated among high-risk providers.

Mandatory review of a prescription drug monitoring program and impact on opioid and benzodiazepine dispensing

“…Prescriber utilization has increased with the integration of PDMPs within electronic medical records, and many states now require daily reporting of data. It is therefore not surprising that early PDMP studies reported mixed findings (Rutkow et al, 2015; Islam and McRae, 2014; Ringwalt et al, 2015; Chang et al, 2016); given the varying levels of PDMP implementation and utilization by prescribers.…”

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

“…For example, about 80% of high‐risk prescribers remained so following policy implementation while at most 60% of high‐risk patients persisted. Similarly, we estimate larger policy effects among high‐risk patients than high‐risk prescribers at 1 year as well; for example, we estimate a 25% to 70% reduction in total opioid volume among high‐risk patients compared with a 13.5% reduction among high‐risk prescribers . Further study is necessary to evaluate these differential effects.…”

“…Many studies suggest that these policies can reduce prescription opioid utilization and deaths . However, some studies fail to identify such impact .…”

“…However, some studies fail to identify such impact . Primarily focused on Florida given its role as an epicenter of nonmedical prescription opioid use, our work found that Florida's PDMP and pill mill law were associated with modest declines in overall opioid sales and that these declines were concentrated among the highest prescribing physicians …”

Quantity fluctuations of illicitly used opioids and overdose risk

“…Although we examined self-reported quantities of opioids used and not empirically determined doses, these findings may be tapping into the same underlying relationship between volatility in actual dose, tolerance, and overdose risk. Better understanding this relationship as well as any other novel overdose risk factors is particularly important in context of the evolving opioid epidemic, where opioid stewardship initiatives are constricting prescribing and the availability of diverted prescription opioids (Chang et al, 2016; Lyapustina et al, 2016; Rutkow et al, 2015) and both rates of heroin use (United Nations Office on Drugs and Crime, 2016) and deaths from synthetic opioids (Rudd, Seth, David, & Scholl, 2016) are increasing.…”