State Legal Restrictions and Prescription-Opioid Use among Disabled Adults

Abstract

BACKGROUND In response to rising rates of opioid abuse and overdose, U.S. states enacted laws to restrict the prescribing and dispensing of controlled substances. The effect of these laws on opioid use is unclear. METHODS We tested associations between prescription-opioid receipt and state controlled-substances laws. Using Medicare administrative data for fee-for-service disabled beneficiaries 21 to 64 years of age who were alive throughout the calendar year (8.7 million person-years from 2006 through 2012) and an original data set of laws (e.g., prescription-drug monitoring programs), we examined the annual prevalence of beneficiaries with four or more opioid prescribers, prescriptions yielding a daily morphine-equivalent dose (MED) of more than 120 mg, and treatment for nonfatal prescription-opioid overdose. We estimated how opioid outcomes varied according to eight types of laws. RESULTS From 2006 through 2012, states added 81 controlled-substance laws. Opioid receipt and potentially hazardous prescription patterns were common. In 2012 alone, 47% of beneficiaries filled opioid prescriptions (25% in one to three calendar quarters and 22% in every calendar quarter); 8% had four or more opioid prescribers; 5% had prescriptions yielding a daily MED of more than 120 mg in any calendar quarter; and 0.3% were treated for a nonfatal prescription-opioid overdose. We observed no significant associations between opioid outcomes and specific types of laws or the number of types enacted. For example, the percentage of beneficiaries with a prescription yielding a daily MED of more than 120 mg did not decline after adoption of a prescription-drug monitoring program (0.27 percentage points; 95% confidence interval, −0.05 to 0.59). CONCLUSIONS Adoption of controlled-substance laws was not associated with reductions in potentially hazardous use of opioids or overdose among disabled Medicare beneficiaries, a population particularly at risk.

Mortality Quadrupled Among Opioid-Driven Hospitalizations, Notably Within Lower-Income And Disabled White Populations

“…For instance, laws that restrict the prescribing and dispensing of opioids have not been associated with reduced opioid use or overdose among disabled Medicare beneficiaries. 44 …”

Addressing the Opioid Epidemic: Is There a Role for Physician Education?

“…The clinical use of opioids in the United States has quadrupled since 1999, contributing to the rise in drug overdoses, emergency room visits, and admissions for drug treatment. Despite significant efforts to restrict the prescribing of opioids over the past decade, prescription opioid abuse and drug overdoses due to prescription opioids have continued to rise (Health and Human Services, 2014; Meara et al, 2016). …”

A path out: Prescription drug abuse, treatment, and suicide

“…Most studies in the first category find mixed or no effect of PDMPs on aggregate outcomes. For example, a recent large scale study, Meara et al (2016), finds weak evidence of effects of state laws, including PDMPs, on drug sales. Using Medicare data, Meara et al (2016) finds no effect of the average state-level reform during the 2006-2012 period; suggestive evidence showing reductions in sales do not survive corrections for multiple hypothesis testing.…”

“…For example, a recent large scale study, Meara et al (2016), finds weak evidence of effects of state laws, including PDMPs, on drug sales. Using Medicare data, Meara et al (2016) finds no effect of the average state-level reform during the 2006-2012 period; suggestive evidence showing reductions in sales do not survive corrections for multiple hypothesis testing. These results contrast with Moyo et al (2017), which finds significant reductions in the total volume of opioids dispensed to Medicare patients following implementation of PDMPs.…”