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Opioid Prescribing May be Impervious to State Laws

By HealthLeaders Media News  
   July 20, 2016

Drug monitoring laws are on the rise, but their effectiveness in curbing the prescribed use of hydromorphone, oxycodone, and other opioids for pain is unclear.

States are increasingly implementing laws that aim to curb opioid abuse, addiction, and overdose, but their effectiveness is unclear, judging by two studies with conflicting results.

One study, published in Health Affairs, finds that state prescription drug monitoring programs may help curb opioid overdoses because they help to reduce prescribing.

Weill Cornell Medicine researchers analyzed 10 years of data from the National Ambulatory Medical Care Survey, which collects information on patients, office visits, and clinicians.

They analyzed 26,275 ambulatory care office visits for pain that occurred in 24 states that had upgraded or implemented drug monitoring programs during the 2001-2010 study period.

What they found was that "the implementation of a prescription drug monitoring program was associated with more than a 30% reduction in the rate of prescribing of Schedule II opioids."

This reduction immediately followed the launch of the program "and was maintained in the second and third years afterward," according to the study abstract.

Schedule II opioids, which include hydromorphone, meperidine, oxycodone, and fentanyl, are the most-addictive painkillers. The study also found that the programs' effects on "overall opioid prescribing and prescribing of non-opioid analgesics were limited."

Contradictory Findings

When it comes to the most vulnerable populations, however, these laws may have little effect, finds a different study in the New England Journal of Medicine.

Researchers from UCLA School of Law and the Dartmouth Institute of Health Policy and Clinical Practice examined a national population of 2.2 million disabled Medicare beneficiaries ages 21 to 64.

They found no significant association between state laws and hazardous prescribing patterns, such as very high daily opioid doses and the rate of nonfatal overdose.

Although states added 81 controlled-substance laws from 2006 through 2012, in "2012 alone, 47% of beneficiaries filled opioid prescriptions [and] 8% had four or more opioid prescribers," the study abstract said.

In fact, the researchers observed no "significant associations between opioid outcomes and specific types of laws or the number of types enacted.

The percentage of beneficiaries with a prescription yielding a daily [morphine-equivalent dose] of more than 120 mg did not decline after adoption of a prescription-drug monitoring program."

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