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Comparative Study
. 2018 Apr;27(4):422-429.
doi: 10.1002/pds.4404. Epub 2018 Feb 28.

Impact of Florida's prescription drug monitoring program and pill mill law on high-risk patients: A comparative interrupted time series analysis

Hsien-Yen Chang  1   2 , Irene Murimi  2   3 , Mark Faul  4 , Lainie Rutkow  1 , G Caleb Alexander  2   3   5
Affiliations
Comparative Study

Impact of Florida's prescription drug monitoring program and pill mill law on high-risk patients: A comparative interrupted time series analysis

Hsien-Yen Chang et al. Pharmacoepidemiol Drug Saf. 2018 Apr.

Abstract

Purpose: We quantified the effects of Florida's prescription drug monitoring program and pill mill law on high-risk patients.

Methods: We used QuintilesIMS LRx Lifelink data to identify patients receiving prescription opioids in Florida (intervention state, N: 1.13 million) and Georgia (control state, N: 0.54 million). The preintervention, intervention, and postintervention periods were July 2010 to June 2011, July 2011 to September 2011, and October 2011 to September 2012. We identified 3 types of high-risk patients: (1) concomitant users: patients with concomitant use of benzodiazepines and opioids; (2) chronic users: long-term, high-dose, opioid users; and (3) opioid shoppers: patients receiving opioids from multiple sources. We compared changes in opioid prescriptions between Florida and Georgia before and after policy implementation among high-risk/low-risk patients. Our monthly measures included (1) average morphine milligram equivalent per transaction, (2) total opioid volume across all prescriptions, (3) average days supplied per transaction, and (4) total number of opioid prescriptions dispensed.

Results: Among opioid-receiving individuals in Florida, 6.62% were concomitant users, 1.96% were chronic users, and 0.46% were opioid shoppers. Following policy implementation, Florida's high-risk patients experienced relative reductions in morphine milligram equivalent (opioid shoppers: -1.08 mg/month, 95% confidence interval [CI] -1.62 to -0.54), total opioid volume (chronic users: -4.58 kg/month, CI -5.41 to -3.76), and number of dispensed opioid prescriptions (concomitant users: -640 prescriptions/month, CI -950 to -340). Low-risk patients generally did not experience statistically significantly relative reductions.

Conclusions: Compared with Georgia, Florida's prescription drug monitoring program and pill mill law were associated with large relative reductions in prescription opioid utilization among high-risk patients.

Keywords: chronic opioid users; concomitant users of benzodiazepines and opioids; long-term opioid therapy; opioid shoppers; pharmacoepidemiology; pill mill law; prescription drug abuse; prescription drug monitoring program; time series analysis.

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Conflict of interest statement

CONFLICT OF INTEREST

Dr Alexander is chair of the FDA’s Peripheral and Central Nervous System Advisory Committee; serves on the Advisory Board of MesaRx Innovations; holds equity in Monument Analytics, a health care consultancy whose clients include the life sciences industry as well as plaintiffs in opioid litigation; and serves as a member of OptumRx’s P&T Committee. This arrangement has been reviewed and approved by Johns Hopkins University in accordance with its conflict of interest policies. The statements, findings, conclusions, views, and opinions contained and expressed in this article are based in part on data obtained under license from the following QuintilesIMS Health Incorporated information service(s): QuintilesIMS Health LifeLink LRx Database® (2010-2012), QuintilesIMS Health Incorporated. All Rights Reserved. The statements, findings, conclusions, views, and opinions contained and expressed herein are not necessarily those of QuintilesIMS Health Incorporated or any of its affiliated or subsidiary entities.

Figures

FIGURE 1
FIGURE 1
Policy impact on the prevalence of high-risk patients by period and state
See this image and copyright information in PMC

References

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