Prescription Fentanyl Reductions and Opioid Prescribing Laws

MedicalResearch.com Interview with:

Brian J. Piper, PhD, MS Department of Basic Sciences Geisinger Commonwealth School of Medicine Scranton, PA 18509

Dr. Brian Piper

Brian J. Piper, PhD, MS
Assistant Professor of Neuroscience
Geisinger Commonwealth School of Medicine

MedicalResearch.com: What is the background for this study?

Response: Fentanyl is an important opioid for pain management but also has exceptional potential for misuse. Illicitly manufactured fentanyl accounts for a large portion of opioid overdoses. Seven states including Maine, Connecticut, Massachusetts, New York, Rhode Island, and Vermont have recently implemented opioid prescribing laws. The objectives of this study were to:

  • 1) characterize how medical use of fentanyl, fentanyl analogues like sufentanil, alfentanil, and remifentanil, and other opioid use changed over the past decade, and
  • 2) determine whether opioid prescribing laws impacted fentanyl use in the US.

    The Drug Enforcement Administration’s Automation of Reports and Consolidated Ordering System (ARCOS) is the gold-standard for pharmacoepidemiology research of controlled substances in the US for its comprehensiveness. 

MedicalResearch.com: What are the main findings?

Response: The national reduction in per capita use of fentanyl from 2016 to 2017 (-17.9%) exceeded the changes in hydrocodone (-12.3%), oxycodone (-10.1%), morphine (-13.3%) or codeine (-8.8%).

There was greater than a three-fold variation in the percent decrease in fentanyl use between states (minimum = -10.3% in Mississippi, maximum = -36.0% in Maine). Hospital use of remifentanil and sufentanil tripled from 2006 to 2017. The state (Maine) with the most comprehensive opioid-prescribing legislation showed a decline in fentanyl use that was over twice as great as states that had not implemented an opioid-prescribing law. The reduction in opioids used for pain was significantly larger among states that had a narrow opioid-prescribing law (-27.3%) than in states without a law (-22.7%). 

MedicalResearch.com: What should readers take away from your report?

Response:

  • Prescription opioid use in the US continues to be reduced relative to the peak in 2011.
  • Second, the legislation in Maine included mandatory Prescription Drug Monitoring Program enrollment and use by prescribers, a limit on the supply of acute opioid prescriptions (7 days), an opioid prescribing cap (100 morphine-mg-equivalent daily dose), and penalties for prescriber non-adherence to these regulations. Maine’s law was unique in including financial penalties.

    Of course, further research is necessary but this research serves an important development which is relevant for others considering a national law in the US or in other countries interested in preventing the missteps of the US.

MedicalResearch.com: Is there anything else you would like to add?

Response: ARCOS is an amazing resource which is publically available from the Drug Enforcement Administration’s website. We continue to be surprised that few other investigators or data journalists make use of this free and easy to use data source for their own controlled substance research.

Citation: Collins LK, Pande LJ, Chung DY, Nichols SD, McCall KL, Piper BJ. Trends in the medical supply of fentanyl and fentanyl analogues: United States, 2006 to 2017. Preventive Medicine 2019; doi: 10.1016/j.ypmed.2019.02.017 

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