Opioid Use for Pain Management After Implementation of a Medicaid Short-Acting Opioid Quantity Limit

Riggs, Catherine; Billups, Sarah J.; Flores, Samantha; Patel, Ratna; Heilmann, Rachel M. F.; Milchak, Jessica L.

doi:10.18553/jmcp.2017.23.3.346

Cited by 14 publications

(9 citation statements)

References 7 publications

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“…29 In recent years, there have been many other approaches of DUR programs undertaken by insurers that showed great promise, such as intervention on high-dose opioid and opioid and CNS combination therapy, short-acting opioid quantity limit, and opioid tapering programs for conditions of the back and spine. 24,30,31 Assessment of the synergy of combined interventions and evaluation of the effect on health outcomes of these utilization management programs are needed to enrich the knowledge base of such programs, maximize program utility, and ultimately optimize resource allocations.…”

Section: Discussionmentioning

confidence: 99%

Effect of Controlled Substance Use Management on Prescribing Patterns and Health Outcomes Among High-Risk Users

Chen

Barron

et al. 2019

JMCP

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BACKGROUND: The misuse of prescription drugs is a serious public health problem. Although controlled substance (CS) prescribing, in particular, opioid analgesics, has recently declined, the volume of prescriptions in 2015 was still 3 times higher than in 1999. To curb the high volume of CS prescribing, a national health plan has implemented a controlled substance utilization management (CSUM) program, a prescriber-focused educational intervention regarding patients at risk for CS misuse. OBJECTIVE: To characterize the effect of the CSUM program on CS prescribing volumes, number of prescribers and other health outcomes (opioid overdoses, all-cause emergency department visits, and all-cause hospitalizations). METHODS:The CSUM program identified patients who received ≥ 10 CS prescriptions within any 3-month window for noncancer pain as being high risk for CS misuse and mailed patient medication profiles to their CS prescribers. This retrospective study was conducted on patients whose prescribers were contacted by the CSUM program from January 2014 to December 2015. The reference group included patients with carved-out pharmacy benefits who were 1:1 propensity score matched to the program group. CS prescribing volumes, number of CS prescribers, and other health care utilization measures were assessed in the 6-month pre-intervention (baseline) period and 6-month post-intervention (follow-up) period using difference-in-difference (DID) analysis. RESULTS: After matching, each group had 17,295 patients, and there were no differences in baseline demographic and clinical characteristics. During the follow-up period, the CSUM group had 1.1 fewer prescriptions for CS (mean difference [MD] within group -3.2 vs. -2.1 prescriptions), 21 fewer days of supply (MD -27 vs. -6 days), and 0.2 fewer number of CS prescribers (MD -0.8 vs. -0.6 prescribers) per patient when compared with the reference group; all P values were < 0.001. The reductions in CS prescribing volumes and number of prescribers within the CSUM group were mainly driven by opioid analgesics, with minimal differences in benzodiazepines and stimulants between the 2 groups. The CSUM program had no significant effect on the opioid dosage strength but was associated with a lower rate of all-cause emergency department visits. CONCLUSIONS:The CSUM program had a moderate positive effect on reducing CS prescribing volumes and number of CS prescribers compared with a reference group. Beside the focus on patients who have already received 10+ CS prescriptions, there remains a need for more intensive approaches for accelerating targeted declines in CS in general and opioids in particular.

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Section: Discussionmentioning

confidence: 99%

Effect of Controlled Substance Use Management on Prescribing Patterns and Health Outcomes Among High-Risk Users

Chen

Barron

et al. 2019

JMCP

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“…With an expectation to reduce high-dose opioid prescribing, almost all CCOs implemented some form of quantity limit restriction, an approach that has generally been shown to curb high-risk opioid prescriptions. (Riggs et al, 2017) Many CCOs, recognizing that an adequate tapering plan is critical for patients on high opioid doses, established taper plan processes accompanied by varying levels of provider guidance. More robust provider guidance and support, however, may be needed to successfully taper patients who have received high-dose opioids for many years, including information about managing withdrawal symptoms, alternative treatments, and the need for psychosocial support for patients.…”

Section: Discussionmentioning

confidence: 99%

“…(Losby, Hyatt, Kanter, Baldwin, & Matsuoka, 2017; Trafton et al, 2010) Finally, healthcare payers are developing and aligning reimbursement strategies that incentivize safer opioid prescribing and encourage non-opioid interventions for pain management. (Cochran et al, 2017; Faul, Bohm, & Alexander, 2017; Garcia et al, 2016; Riggs et al, 2017)…”

Section: Introductionmentioning

confidence: 99%

A statewide effort to reduce high-dose opioid prescribing through coordinated care organizations

Hartung

Alley

Leichtling

et al. 2018

Addictive Behaviors

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“…51 Similarly, a policy that limited the number of Medicaid-reimbursed short-acting opioids in Colorado was associated with a 3% decrease in the number of overall daily prescriptions reimbursed. 53 Clinical guidelines. Limited evidence exists on the effect of clinical guidelines for prescribing opioids 55,56 and no studies .…”

Section: Impact Of Systems-level Interventions On Opioid Use Overdosmentioning

confidence: 99%

A Rapid Review of the Impact of Systems-Level Policies and Interventions on Population-Level Outcomes Related to the Opioid Epidemic, United States and Canada, 2014-2018

et al. 2020

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Objectives In the United States, rising rates of overdose deaths and recent outbreaks of hepatitis C virus and HIV infection are associated with injection drug use. We updated a 2014 review of systems-level opioid policy interventions by focusing on evidence published during 2014-2018 and new and expanded opioid policies. Methods We searched the MEDLINE database, consistent with the 2014 review. We included articles that provided original empirical evidence on the effects of systems-level interventions on opioid use, overdose, or death; were from the United States or Canada; had a clear comparison group; and were published from January 1, 2014, through July 19, 2018. Two raters screened articles and extracted full-text data for qualitative synthesis of consistent or contradictory findings across studies. Given the rapidly evolving field, the review was supplemented with a search of additional articles through November 17, 2019, to assess consistency of more recent findings. Results The keyword search yielded 535 studies, 66 of which met inclusion criteria. The most studied interventions were prescription drug monitoring programs (PDMPs) (59.1%), and the least studied interventions were clinical guideline changes (7.6%). The most common outcome was opioid use (77.3%). Few articles evaluated combination interventions (18.2%). Study findings included the following: PDMP effectiveness depends on policy design, with robust PDMPs needed for impact; health insurer and pharmacy benefit management strategies, pill-mill laws, pain clinic regulations, and patient/health care provider educational interventions reduced inappropriate prescribing; and marijuana laws led to a decrease in adverse opioid-related outcomes. Naloxone distribution programs were understudied, and evidence of their effectiveness was mixed. In the evidence published after our search’s 4-year window, findings on opioid guidelines and education were consistent and findings for other policies differed. Conclusions Although robust PDMPs and marijuana laws are promising, they do not target all outcomes, and multipronged interventions are needed. Future research should address marijuana laws, harm-reduction interventions, health insurer policies, patient/health care provider education, and the effects of simultaneous interventions on opioid-related outcomes.

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Opioid Use for Pain Management After Implementation of a Medicaid Short-Acting Opioid Quantity Limit

Cited by 14 publications

References 7 publications

Effect of Controlled Substance Use Management on Prescribing Patterns and Health Outcomes Among High-Risk Users

Effect of Controlled Substance Use Management on Prescribing Patterns and Health Outcomes Among High-Risk Users

A statewide effort to reduce high-dose opioid prescribing through coordinated care organizations

A Rapid Review of the Impact of Systems-Level Policies and Interventions on Population-Level Outcomes Related to the Opioid Epidemic, United States and Canada, 2014-2018

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