24 Jun Opioid-Restricting Laws Have Not Reduced Overdoses in Disabled Workers
MedicalResearch.com Interview with:
Professor Ellen Meara, PhD
The Dartmouth Institute for Health Policy and Clinical Practice
MedicalResearch.com: What is the background for this study?
Response: Responding to a fourfold rise in death rates, between 2006 and 2012, states collectively enacted 81 laws restricting prescribing and dispensing of prescription opioids. Jill Horwitz, PhD, JD, said “states hoped passing a range of laws might help. So they are enacting small fixes — forbidding patients from “doctor-shopping,” and requiring doctors to use tamper-resistant prescription forms. They are also implementing major efforts such as prescription drug monitoring programs (PDMPs) — online databases that allow law enforcement and clinicians to monitor prescriptions.”
MedicalResearch.com: What are the main findings?
Response: The laws do not change the chance of overdose, or the opioid use leading up to it for disabled workers, a large population with high opioid use. People in this group, presumably a population the laws aim to protect, are 10 times more likely than average to die of prescription opioid overdose.
MedicalResearch.com: What should readers take away from your report?
Response: We need to be honest about what works and what doesn’t as we address the opioid epidemic. States are working very hard to address the problem, but we lack the evidence we need to focus all our efforts on remedies that will save lives.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: There are two areas at the top of my list.
First, states have put in place more sophisticated laws since the end of our study period. I am optimistic that some provisions may be more effective at curbing opioid overdose and the misuse of prescription opioids leading up to it. We should continue to examine these laws closely and critically to identify what works.
Second, we could, with existing data, learn much more about the pattern of prescribing and contact with the health care system that precedes overdose. For example, we know that most opioids (in terms of the quantity of opioids) are prescribed by a very small percent of prescribers. Just as we think that surgeons performing many procedures are likely to be more skilled than surgeons performing a handful of procedures, there are reasons to think that “high volume” opioid prescribers could do a better job prescribing than low volume prescribers.
At the same time, we know that some high volume prescribers have been the source of opioids that have been diverted for misuse, abuse, and overdose. We can learn more about what types of prescribing are associated with better patient outcomes, as well as the reverse, what predicts the problems we have seen with prescription opioids. Research on different types of opioid prescribers might identify other promising ways to prevent misuse of opioids and overdose.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Ellen Meara, Jill R. Horwitz, Wilson Powell, Lynn McClelland, Weiping Zhou, A. James O’Malley, Nancy E. Morden. State Legal Restrictions and Prescription-Opioid Use among Disabled Adults. New England Journal of Medicine, 2016; DOI: 10.1056/NEJMsa1514387
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