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High-Dose Opioid Prescribing in Individuals with Acute Pain: Assessing the Effects of US State Opioid Policies.

Authors :
Bradford AC
Nguyen T
Schulson L
Dick A
Gupta S
Simon K
Stein BD
Source :
Journal of general internal medicine [J Gen Intern Med] 2024 Nov; Vol. 39 (14), pp. 2689-2697. Date of Electronic Publication: 2024 Jul 19.
Publication Year :
2024

Abstract

Background: How state opioid policy environments with multiple concurrent policies affect opioid prescribing to individuals with acute pain is unknown.<br />Objective: To examine how prescription drug monitoring programs (PDMPs), pain management clinic regulations, initial prescription duration limits, and mandatory continued medical education affected total and high-dose prescribing.<br />Design: A county-level multiple-policy difference-in-difference event study framework.<br />Subjects: A total of 2,425,643 individuals in a large national commercial insurance deidentified claims database (aged 12-64 years) with acute pain diagnoses and opioid prescriptions from 2007 to 2019.<br />Main Measures: The total number of acute pain opioid treatment episodes and number of episodes containing high-dose (> 90 morphine equivalent daily dosage (MEDD)) prescriptions.<br />Key Results: Approximately 7.5% of acute pain episodes were categorized as high-dose episodes. Prescription duration limits were associated with increases in the number of total episodes; no other policy was found to have a significant impact. Beginning five quarters after implementation, counties in states with pain management clinic regulations experienced a sustained 50% relative decline in the number of episodes containing > 90 MEDD prescriptions (95 CIs: (Q5: - 0.506, - 0.144; Q12: - 1.000, - 0.290)). Mandated continuing medical education regarding the treatment of pain was associated with a 50-75% relative increase in number of high-dose episodes following the first year-and-a-half of enactment (95 CIs: (Q7: 0.351, 0.869; Q12: 0.413, 1.107)). Initial prescription duration limits were associated with an initial relative reduction of 25% in high-dose prescribing, with the effect increasing over time (95 CI: (Q12: - 0.967, - 0.335). There was no evidence that PDMPs affected high-dose opioids dispensed to individuals with acute pain. Other high-risk prescribing indicators were explored as well; no consistent policy impacts were found.<br />Conclusions: State opioid policies may have differential effects on high-dose opioid dispensing in individuals with acute pain. Policymakers should consider effectiveness of individual policies in the presence of other opioid policies to address the ongoing opioid crisis.<br /> (© 2024. The Author(s), under exclusive licence to Society of General Internal Medicine.)

Details

Language :
English
ISSN :
1525-1497
Volume :
39
Issue :
14
Database :
MEDLINE
Journal :
Journal of general internal medicine
Publication Type :
Academic Journal
Accession number :
39028403
Full Text :
https://doi.org/10.1007/s11606-024-08947-9