Impact of Sequential Opioid Dose Reduction Interventions in a State Medicaid Program Between 2002 and 2017

Changes in early high‐risk opioid prescribing practices after policy interventions in Washington State

“… 24 A sequential and progressive opioid dose reduction strategy involving both prior authorization and high‐dose thresholds was successful in decreasing the average daily opioid dose among Massachusetts Medicaid members. 25 At the national level, a study that included 38 intervention and comparison states found that mandated prescription monitoring program (PMP) review and pain clinic laws were associated with reductions in opioid prescribing rates. 26 Using time series analyses, researchers found that several opioid prescribing practices were decreasing before release of the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain, but that guideline release was associated with an even greater decline.…”

“…Evaluations of the 2007 opioid prescribing guideline implemented in Washington State—the first state to implement an opioid guideline specifying a high‐dose threshold (120 mg MEDD) and related clinical guidance—found associated reductions in high‐dose prescribing using both workers’ compensation (WC) pharmacy data 23 and Medicaid data 24 . A sequential and progressive opioid dose reduction strategy involving both prior authorization and high‐dose thresholds was successful in decreasing the average daily opioid dose among Massachusetts Medicaid members 25 . At the national level, a study that included 38 intervention and comparison states found that mandated prescription monitoring program (PMP) review and pain clinic laws were associated with reductions in opioid prescribing rates 26 .…”

Balancing the Risks and Benefits of Opioid Therapy: The Pill and the Pendulum

“…2 These emerging phenomena suggest that the pendulum is swinging back toward more restrictive prescribing practices that have occurred in the wake of recent health care policy and regulatory changes. 3 Yet, it is unclear whether these reactionary approaches to curtailing opioid prescribing will lead to a sustainable balance of the risks and benefits of opioids for adults with chronic pain. 4 Many experts deem the opioid crisis to be a predictable consequence of increased awareness about the deleterious effects of inadequately treated chronic pain.…”