Monday, August 17, 2015

Florida’s efforts to prevent inappropriate use of painkillers are showing reductions among prescribers and patients who had the highest prescribing and usage rates, according to a study out today in JAMA Internal Medicine.

This study explored how the state’s laws worked to impact prescribing and use of painkillers from July 2010 through September 2012. Prescription painkillers commonly contain an opioid, such as oxycodone, and are sold under many different trade names.

The policies were associated with approximately a 1.4 percent decrease in opioid prescriptions, a 2.5 percent decrease in opioid volume, and a 5.6 percent decrease in the morphine milligram equivalent per transaction, which is the amount of opioid actually included in the prescription. The reductions were seen only for prescribers and patients who had the highest prescribing and usage rates.

In 2010, among the 100 US physicians purchasing the greatest amounts of oxycodone, 90 were in Florida. As a direct response, Florida’s legislature adopted a law in 2010 to combat pill mills, rogue pain management clinics where prescription drugs are inappropriately prescribed and dispensed. Florida also launched a prescription monitoring program in 2011 to track prescriptions and provide clinicians with information to review patient history and prevent doctor shopping.

“Sales of opioids are highly correlated with rates of injuries and death from their use, so it’s very important that we now know that pill mill laws and prescription drug monitoring programs working together can reduce sales to the heaviest users,” said Lainie Rutkow, JD, PhD, MPH, associate professor at Johns Hopkins Bloomberg School of Public Health and the study’s lead author.

The study included 2.6 million patients, more than 430,000 prescribers and about 2,800 pharmacies. This group filled about 480 million prescriptions between July 2010 and September 2012, almost 8 percent of which were for opioids. The study compared Florida’s levels of prescriptions and use of painkillers with levels in Georgia, which did not have either law at the time.

“Most prescribers support policies that limit access to opioids,” said Rutkow. “Given this support, and the reductions we have seen in this study, other states may want to consider this as a viable regulatory strategy for addressing opioid abuse in their communities.”

Beyond legislation, the study authors also suggest that states should engage in targeted outreach campaigns to the most frequent prescribers, and encourage drug treatment services for patients since recent findings have confirmed that individuals who have misused opioids often turn to heroin when prescription supplies decrease or access becomes limited.

Other states where similar laws are in place include Alabama, Florida, Georgia, Indiana, Kentucky, Louisiana, Mississippi, Ohio, Tennessee, Texas and West Virginia.

Read the article.

Bethany Saxon
Public Health Law Research