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 To address so-called “pill mills,” or rogue pain management clinics
where prescription opioids were being inappropriately prescribed or
dispensed, Florida passed legislation in 2010 requiring the centers
to register with the state and be owned by doctors.
The state also established a Prescription Drug Monitoring Program (PDMP),
which became operational in September 2011.
A year after both changes took effect, these policies were linked to
a 1.4 percent decrease in opioid prescriptions, the researchers
report in JAMA Internal Medicine.
Their calculations are based on the difference between actual
pharmacy claims data and estimates of what would have happened
without the law in place.
“It’s possible over time that more substantial changes will be
observed,” lead study author Lainie Rutkow, a researcher at Johns
Hopkins Bloomberg School of Public Health, said by email.
Opioids work by interfering with the nervous system’s transmission
of pain signals, but they can also produce a high by stimulating
pleasure centers in the brain. The most commonly abused opioids
include oxycodone, hydrocodone and meperidine.
The amount of prescription painkillers dispensed in the U.S. and
related deaths quadrupled from 1999 to 2013, even though the number
of Americans suffering from pain remained unchanged, according to
the Centers for Disease Control and Prevention.
About a decade ago, Florida emerged as the epicenter of opiate
misuse, addiction and related deaths, with opioid-related surging 80
percent from 2003 to 2009, the researchers note.
By 2010, 90 of the 100 U.S. physicians purchasing the highest
amounts of oxycodone were in Florida.
To understand the impact of Florida’s “pill mill” law on opioid use
in the state, researchers reviewed 480 million prescriptions from
July 2010 to September 2012 in the state as well as in neighboring
Georgia, which didn’t have a similar law.
Overall, about 8 percent of the prescriptions were for opioids. The
database included records for 2.6 million patients, almost 432,000
prescribers and roughly 2,800 pharmacies.
Over the study period, total opioid volume decreased 4 percent in
Florida and 2.3 percent in Georgia, based on the weight of the
prescribed drugs.
Reductions were limited to prescribers and patients who had written
or filled the highest volume of opioid prescriptions.
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One limitation of the study is its reliance on retail pharmacies,
which includes most but not all prescriptions, the researchers
acknowledge. The study also couldn’t determine the separate effect
of Florida’s policies regulating pill mills and tracking
prescriptions because they took effect at about the same time.
Nor did the study track whether the decrease in opioid prescriptions
was linked to fewer overdoses or deaths.
Even so, the findings suggest that Florida’s policies are having the
intended effect, said Dr. Laxmaiah Manchikanti, a researcher at the
University of Louisville and medical director of the Pain Management
Center of Paducah in Kentucky.
“Both are meant to control abuse and excessive use and illegitimate
use of medications,” Manchikanti, who wasn’t involved in the study,
said by email. “Florida’s pill mill law has achieved these goals.”
Andrew Rosenblum, executive director of the National Development and
Research Institutes, a non-profit health group based in New York,
told Reuters Health by email that in addition to pill mill and
prescription monitoring laws, other strategies for cutting opioid
overuse include educating patients about risks and encouraging
doctors to limit the number of medications prescribed, particularly
for short-term pain relief after surgery or dental work,
Rosenblum, who wasn’t involved in the study, added, “In many cases,
patients may require careful selection and careful monitoring. This
apparently was not happening among so-called pill mills.”
SOURCE: http://bit.ly/1NBaZad JAMA Internal Medicine, online August
17, 2015.
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