03 Jun Florida Prescription Drug Monitoring Program Modestly Reduced Opioid Prescriptions By Top Prescribers
MedicalResearch.com Interview with:
Hsien-Yen Chang PhD
Johns Hopkins Bloomberg School of Public Health
Department of Health Policy & Management
Center for Drug Safety & Effectiveness
MedicalResearch.com: What is the background for this study?
Dr. Chang: Prescription opioid addiction and non-medical use are significant public health problems, responsible for about 44 daily overdose deaths in the United States. Although there are no magic bullets to address these issues, policy makers play an important role in shaping regulatory, payment and public health policies to reduce opioid-related injuries and deaths. For example, state policy-makers in the United States have used prescription drug monitoring programs (PDMPs) and “pill mill” laws to address the prescription opioid epidemic. While there is growing evidence regarding the effect of these approaches on opioid sales, little is known about how they affect specific groups of prescribers. This is important, as approximately 20% of U.S. physicians are responsible for prescribing 80% of all opioid analgesics. Therefore, in this study we evaluated the impact of PDMPs and pill mill laws on the clinical practices of high-risk prescribers in Florida, such as their total number of prescription-filling patients with an opioid prescription. Furthermore, we also characterized the concentration of opioid volume and prescriptions among this group of prescribers as well as how the policies of interest impacted these measures.
MedicalResearch.com: What are the main findings?
Dr. Chang: We found that the 4% of prescribers who we deemed high risk accounted for two-thirds of the opioid volume and two-fifths of the total opioid prescriptions dispensed in Florida during the pre-intervention period. Florida’s prescription drug monitoring programs and pill mill law were associated with statistically and clinically significant reductions in five of the seven outcomes that we examined among high-risk prescribers, with virtually no effect on their lower-risk counterparts. For example, one year after the laws went into effect, opioid prescriptions by the state’s top opioid prescribers dropped by 6.2% compared to the hypothetic situation that the laws were not implemented. Despite this, even following policy implementation, prescribing remained highly concentrated among these same high-risk providers.
MedicalResearch.com: What should readers take away from your report?
Dr. Chang: High-risk opioid prescribers are a unique group of providers who consistently prescribe higher opioid volumes than their peers and are responsible for having prescribed a disproportionate fraction of the opioids in circulation today. The prescribing behavior of the small subset of Florida prescribers who were high-risk was significantly affected by Florida’s PDMP and pill mill law, while low-risk providers were not similarly impacted. Despite this, even following policy implementation, opioid prescribing remained highly concentrated, suggesting continued opportunities to strategically target initiatives to reduce opioid use and, ultimately, opioid-related morbidity and mortality.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Dr. Chang: Prescription drug monitoring programs differ a lot state to state, so it is important to conduct evaluations of other states’ programs. We examine the effect of PDMPs on one important outcome – opioid prescribing – but it’s important that this type of study is coupled with studies examining the effect of PDMPs on injuries and deaths from prescription opioids. Impact on the ultimate target of the state policies, patients, should also be evaluated.
MedicalResearch.com: Is there anything else you would like to add?
Dr. Chang: Since high risk prescribers account for a disproportionate share of opioid volume, it makes sense to target them with regulatory and clinical policies. However, it is important to recognize that a great deal of prescription opioids are prescribed by lower risk prescribers as well. We need different approaches for different prescribers – there is not a one-size-fits-all strategy here.
In addition, It is important to incorporate prescription drug monitoring programs into clinical workflow; the more seamlessly PDMPs can be incorporated into clinical workflow, the greater utility they will provide to clinicians and patients. Checking a PDMP prior to prescribing opioids for a high risk patient should be just as customary as checking a patient’s kidney function before starting a blood pressure medicine. Reducing the opioid epidemic has to begin with prescribers – we have to reduce our over reliance of these products in clinical care.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
G. Caleb Alexander et al. Impact of Prescription Drug Monitoring Programs and Pill Mill Laws on High-Risk Opioid Prescribers: A Comparative Interrupted Time Series Analysis. Drug and Alcohol Dependence, June 2016 DOI: 10.1016/j.drugalcdep.2016.04.033
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