Association of a State Prescribing Limits Policy with Opioid Prescribing and Long-term Use: an Interrupted Time Series Analysis.
Health policy
Long-term opioid use
Opioid prescribing
Prescribing limits
Journal
Journal of general internal medicine
ISSN: 1525-1497
Titre abrégé: J Gen Intern Med
Pays: United States
ID NLM: 8605834
Informations de publication
Date de publication:
Jun 2023
Jun 2023
Historique:
received:
21
07
2022
accepted:
22
12
2022
pmc-release:
01
06
2024
medline:
19
6
2023
pubmed:
8
1
2023
entrez:
7
1
2023
Statut:
ppublish
Résumé
Prescription opioids were a major initial driver of the opioid crisis. States have attempted to reduce overprescribing by enacting policies that limit opioid prescriptions, but the impacts of such policies on new prescribing and subsequent transitions to long-term use are not fully understood. To examine the association of implementation of a state prescribing limits policy with opioid prescribing and transitions to long-term opioid use. Interrupted time series analyses assessing trends in new opioid prescriptions and long-term use before and after policy implementation. A total of 130,591 New Jersey Medicaid enrollees ages 18-64 who received an initial opioid prescription from January 2014 to December 2019. New Jersey's opioid prescribing limit policy implemented in March 2017. Total new opioid prescriptions, percentage of new prescriptions with >5 days' supply, and transition to long-term opioid use, defined as having opioid supply on day 90 after the initial prescription. Policy implementation was associated with a significant monthly increase in new opioid prescriptions of 0.86 per 10,000 enrollees, halving the pre-policy decline in the prescribing rate. Among new opioid prescriptions, the percentage with >5 days' supply decreased by about 1 percentage point (-0.76 percentage points, 95% CI -0.89, -0.62) following policy implementation. However, policy implementation was associated with a significant monthly increase in the rate of initial prescriptions with supply on day 90 (9.95 per 10,000 new prescriptions, 95% CI 4.80, 15.11) that reversed the downward pre-implementation trend. The New Jersey policy was associated with a reduction in initial prescriptions with >5 days' supply, but not with an overall decline in new opioid prescriptions or in the rate at which initial prescriptions led to long-term use. Given their only modest benefits, policymakers and clinicians should carefully weigh potential unintended consequences of strict prescribing limits.
Sections du résumé
BACKGROUND
BACKGROUND
Prescription opioids were a major initial driver of the opioid crisis. States have attempted to reduce overprescribing by enacting policies that limit opioid prescriptions, but the impacts of such policies on new prescribing and subsequent transitions to long-term use are not fully understood.
OBJECTIVE
OBJECTIVE
To examine the association of implementation of a state prescribing limits policy with opioid prescribing and transitions to long-term opioid use.
DESIGN
METHODS
Interrupted time series analyses assessing trends in new opioid prescriptions and long-term use before and after policy implementation.
PATIENTS
METHODS
A total of 130,591 New Jersey Medicaid enrollees ages 18-64 who received an initial opioid prescription from January 2014 to December 2019.
INTERVENTIONS
METHODS
New Jersey's opioid prescribing limit policy implemented in March 2017.
MAIN MEASURES
METHODS
Total new opioid prescriptions, percentage of new prescriptions with >5 days' supply, and transition to long-term opioid use, defined as having opioid supply on day 90 after the initial prescription.
KEY RESULTS
RESULTS
Policy implementation was associated with a significant monthly increase in new opioid prescriptions of 0.86 per 10,000 enrollees, halving the pre-policy decline in the prescribing rate. Among new opioid prescriptions, the percentage with >5 days' supply decreased by about 1 percentage point (-0.76 percentage points, 95% CI -0.89, -0.62) following policy implementation. However, policy implementation was associated with a significant monthly increase in the rate of initial prescriptions with supply on day 90 (9.95 per 10,000 new prescriptions, 95% CI 4.80, 15.11) that reversed the downward pre-implementation trend.
CONCLUSIONS
CONCLUSIONS
The New Jersey policy was associated with a reduction in initial prescriptions with >5 days' supply, but not with an overall decline in new opioid prescriptions or in the rate at which initial prescriptions led to long-term use. Given their only modest benefits, policymakers and clinicians should carefully weigh potential unintended consequences of strict prescribing limits.
Identifiants
pubmed: 36609812
doi: 10.1007/s11606-022-07991-7
pii: 10.1007/s11606-022-07991-7
pmc: PMC10271990
doi:
Substances chimiques
Analgesics, Opioid
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1862-1870Subventions
Organisme : NIDA NIH HHS
ID : K01 DA049950
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR003017
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1TR003017
Pays : United States
Organisme : NIDA NIH HHS
ID : 1R01 DA047347-01
Pays : United States
Informations de copyright
© 2023. The Author(s), under exclusive licence to Society of General Internal Medicine.
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