Do State-Level Opioid Control Programs Decrease Abuse and Diversion?

Like every year, PAINWeek, which kicks off this week in Las Vegas, will include dozens of presentations on abuse and diversion. It is a topic that is always front and center for pain management practitioners, and one for which there are no easy answers.

State governments, intimately aware of the problems that spread far beyond legitimate patients with pain, have in recent years stepped up programs designed to increase the obstacles to abuse and diversion. One such program, the Prescription Drug Monitoring Program (PDMP) initiated in Florida in 2010, was the subject of a study in JAMA Internal Medicine, which measured the program from July 2010 to September 2012, and found a “modest decrease” in the use of opioid prescription drugs.

Florida’s PDMP and changes in state regulations included several provisions, including mandatory state registration of clinics and making it illegal for doctors to dispense opioid prescription painkillers from their offices. The latter provision effectively eliminated the practice of storefront clinics selling prescription medications to walk-in patients carrying cash.

The study used data from neighboring Georgia, which has not implemented a similar program, as a control. The researchers used IMS Health prescribing data and compared it to a closed cohort of more than 2.5 million patients, 430,000 prescribers, 2,800 retail pharmacies, and 480 million prescriptions in both states. Total opioid volume, mean morphine milligram equivalent (MME) per transaction, mean days’ supply per transaction, and total number of opioid prescriptions dispensed were measured.

Florida’s PDMP was associated with statistically significant declines in opioid volume (2.5 kg/mo, P<.05; equivalent to approximately 500000 5—mg tablets of hydrocodone bitartrate per month) and MME per transaction (0.45 mg/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.

The dip in prescribing isn’t dramatic, but it is significant and promising, and the results may indicated to other states that similar provisions may have an impact on abuse and diversion.

Still, overuse of opioids remains a massive problem with no easy solutions. Pain management practitioners and others at PAINWeek will be among those to present on the potential damage that abuse and diversion issues have on the diagnosis and treatment of legitimate pain patients.