Mandatory Provider Review And Pain Clinic Laws Reduce The Amounts Of Opioids Prescribed And Overdose Death Rates

Abstract

To address the opioid overdose epidemic in the United States, states have implemented policies to reduce inappropriate opioid prescribing. These policies could affect the coincident heroin overdose epidemic by either driving the substitution of heroin for opioids or reducing simultaneous use of both substances. We used IMS Health's National Prescription Audit and government mortality data to examine the effect of these policies on opioid prescribing and on prescription opioid and heroin overdose death rates in the United States during 2006-13. The analysis revealed that combined implementation of mandated provider review of state-run prescription drug monitoring program data and pain clinic laws reduced opioid amounts prescribed by 8 percent and prescription opioid overdose death rates by 12 percent. We also observed relatively large but statistically insignificant reductions in heroin overdose death rates after implementation of these policies. This combination of policies was effective, but broader approaches to address these coincident epidemics are needed.

Keywords: Epidemiology; Medicine/Clinical Issues; Pharmaceuticals; Public Health.

Exhibit 1

Opioid prescribing rates by state policy category SOURCES IMS Health’s National Prescription Audit, 2006–13; state populations obtained from CDC WONDER (Wide-ranging Online Data for Epidemiologic Research), 2006–13. NOTES MME is morphine milligram equivalent. PDMP is prescription drug monitoring program.

Exhibit 2

Drug overdose death rates by state policy category SOURCES National Vital Statistics System Multiple Cause of Death mortality files, 2006–13, from the National Center for Health Statistics; state populations obtained from CDC WONDER (Wide-ranging Online Data for Epidemiologic Research), 2006–13. NOTE PDMP is prescription drug monitoring program. ^aCombined drugs include prescription opioids, heroin, and unspecified drugs.