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Florida law limiting first opioid prescription linked to drop in use

(Reuters Health) – A Florida law restricting the quantity of opioids a doctor can prescribe for acute pain to three days’ worth may have led to overall reductions in opioids dispensed to patients in the state, a new study suggests.

After the law was passed in July 2018, doctors wrote fewer and shorter prescriptions for opioids, researchers report in JAMA Network Open.

“The policy was intended to reduce the quantity prescribed but it was not expected to decrease opioid use overall,” said study coauthor Dr. Juan Hincapie-Castillo of the University of Florida College of Pharmacy in Gainesville.

“But fewer people were getting opioids. That means the law led not only to a reduction in the quantity dispensed, but also to a reduction in the initial decision to prescribe.”

At this point it’s not clear what medications doctors were choosing to prescribe in place of opioids, Hincapie-Castillo said. “We know that some patients are not getting opioids, so, are they getting more non-steroidal anti-inflammatory drugs, like ibuprofen or naproxen, or other medications, like gabapentin?” he said. “We don’t know yet.”

While it’s good to see a reduction in the amount of opioids prescribed overall, Hincapie-Castillo worries that laws like the one in Florida might also make doctors less likely to write prescriptions for patients with chronic pain.

“Anecdotally around the country, patients with chronic pain are being tapered off of opioids,” he said. “Their dose is being decreased or stopped altogether.”

Beyond that, laws like the one in Florida might be too broad, Hincapie-Castillo said. “Pain from a tooth extraction is not the same as that from a bone fracture,” he explained. “We have to be sure we are doing everything in our power to control the opioid crisis. But prescribing restrictions need to come down somewhere in the middle because of the effects they can have on patients who legitimately should have these medications.”

To take a closer look at the impact of the new Florida opioid law, Hincapie-Castillo and his colleagues analyzed pharmacy prescription claims for opioids dispensed from January 2015 through March 2019 in a single health plan covering more than 45,000 people.

To focus on patients who were newly prescribed opioids and continuously using the medication, the researchers made sure none had a prescription for the drugs in the previous 180 days. In the end, Hincapie-Castillo and his colleagues identified 8,375 patients with 10,583 unique new opioid prescriptions. There were more prescriptions than patients because individual patients might have had a prescription for opioids more than once during the years covered by the study, Hincapie-Castillo explained.

Before the new legislation, 5.5 per 1,000 patients started a new prescription for opioids. That dropped to 4.6 per 1,000 after the law was implemented.

After the law was in effect, there was also an immediate decrease of 0.48 patients per 1,000 in monthly users of hydrocodone, which is often sold in combination formulas containing ibuprofen or other over the counter pain medicines.

Other weaker opioids also saw a 0.24 per 1,000 drop in monthly users after the law.

The average number of days included in opioid prescriptions also dropped from 5.4 to 4.2 and continued to decrease over the eight months following implementation of the law.

“The study shows that if you change the law, you will likely change prescriber behavior,” said Dr. Yury Khelemsky, an associate professor of anesthesiology, perioperative and pain medicine at the Icahn School of Medicine at Mount Sinai in New York City. “And that make sense because physicians tend to be pretty compliant with regulatory issues.”

With the current opioid crisis, it makes sense to try to change physician prescribing behavior, said Khelemsky, who was not affiliated with the new research. “Clearly there are a lot of people suffering from addiction and a lot of people dying from these medications,” he added. “I think it’s a good idea to have physicians be more careful with prescribing and essentially keeping tabs on the patient.”

SOURCE: JAMA Network Open, online February 28, 2020.

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