Effect of Florida's Prescription Drug Monitoring Program and Pill Mill Laws on Opioid Prescribing and Use
Effect of Florida's Prescription Drug Monitoring Program and Pill Mill Laws on Opioid Prescribing and Use
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DOI：
10.1001/jamainternmed.2015.3931
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发表时间：
2015-10-01
影响因子：
39
通讯作者：
Alexander, G. Caleb
中科院分区：
文献类型：
--
作者：
Rutkow, Lainie;Chang, Hsien-Yen;Alexander, G. Caleb
目的为了量化佛罗里达州(干预州)和佐治亚州(控制州)的重要性处方药监测计划(PDMP)和药厂法对总体和高风险阿片类药物处方和使用的影响。我们对IMS Health LifeLink LRx数据进行了比较中断的时间序列分析，以表征从2010年7月到2012年9月在佛罗里达州(干预州)和佐治亚州(控制州)实施PDMP和药厂法对处方医生、零售药店和患者的封闭队列的影响。我们进行了敏感性分析，包括改变观察时间和修改要求，以便在整个研究期间连续观察个体。MAIN结果和测量阿片类药物总量、每笔交易的平均吗啡毫克当量(MME)、每笔交易的平均供应天数和阿片类药物处方处方总数。结果从2010年7月到2012年9月，260万名患者、431890名处方医生和2829家药店的260万名患者、431890名处方医生和2829家药店与佛罗里达州和佐治亚州约4.8亿张处方有关，其中7.7%是阿片类药物。在实施之前，佛罗里达州的每月阿片类药物总量、每笔交易的MME、天数和处方分配都高于佐治亚州。佛罗里达州的法律与阿片类药物数量(2.5公斤/月，P<；0.05；相当于每月约500,000片重酒石酸氢可酮5片)和每笔交易的MME(0.45 mg/月，P<；0.05)的统计上的显著下降有关，而天数供应没有任何变化。在实施12个月后，这些政策导致阿片类药物处方减少了约1.4%，阿片类药物数量减少了2.5%，每笔交易的MME减少了5.6%。减少仅限于处方人员和阿片类药物处方和使用基线最高的患者。敏感性分析、不同的时间窗口和登记标准支持了主要结果。结论和相关性佛罗里达州的PDMP和药丸厂法律与阿片类药物处方和使用的适度减少有关。阿片类药物处方和使用基线最高的处方者和患者的降幅最大。
IMPORTANCE Prescription Drug Monitoring Program (PDMP) and pill mill laws are among the principal means states use to reduce prescription drug abuse and diversion, yet little high-quality evidence exists regarding their effect.OBJECTIVE To quantify the effect of Florida's PDMP and pill mill laws on overall and high-risk opioid prescribing and use.DESIGN, SETTING, AND PARTICIPANTS We applied comparative interrupted time-series analyses to IMS Health LifeLink LRx data to characterize the effect of PDMP and pill mill law implementation on a closed cohort of prescribers, retail pharmacies, and patients from July 2010 through September 2012 in Florida (intervention state) compared with Georgia (control state). We conducted sensitivity analyses, including varying length of observation and modifying requirements for continuous observation of individuals throughout the study period.MAIN OUTCOMES AND MEASURES Total opioid volume, mean morphine milligram equivalent (MME) per transaction, mean days' supply per transaction, and total number of opioid prescriptions dispensed. Analyses were conducted per prescriber and per patient, in aggregate and after stratifying by volume of baseline opioid prescribing for prescribers and use for patients.RESULTS From July 2010 through September 2012, a cohort of 2.6 million patients, 431 890 prescribers, and 2829 pharmacies was associated with approximately 480 million prescriptions in Florida and Georgia, 7.7% of which were for opioids. Total monthly opioid volume, MME per transaction, days' supply, and prescriptions dispensed were higher in Florida than Georgia before implementation. Florida's laws were associated with statistically significant declines in opioid volume (2.5 kg/mo, P < .05; equivalent to approximately 500 000 5-mg tablets of hydrocodone bitartrate per month) and MME per transaction (0.45mg/mo, P < .05), without any change in days' supply. Twelve months after implementation, the policies were associated with approximately a 1.4% decrease in opioid prescriptions, 2.5% decrease in opioid volume, and 5.6% decrease in MME per transaction. Reductions were limited to prescribers and patients with the highest baseline opioid prescribing and use. Sensitivity analyses, varying time windows, and enrollment criteria supported the main results.CONCLUSIONS AND RELEVANCE Florida's PDMP and pill mill laws were associated with modest decreases in opioid prescribing and use. Decreases were greatest among prescribers and patients with the highest baseline opioid prescribing and use.