Valerie S Harder1,2, Timothy B Plante3, Insu Koh4, Ethan B Rogers5, Susan E Varni5, Andrea C Villanti6, John R Brooklyn6,7, Kathleen M Fairfield8. 1. Department of Pediatrics, The Larner College of Medicine at The University of Vermont, 1 South Prospect Street, Burlington, VT, 05401, USA. Valerie.Harder@uvm.edu. 2. Department of Psychiatry, The Larner College of Medicine at The University of Vermont, 1 South Prospect Street, Burlington, VT, 05401, USA. Valerie.Harder@uvm.edu. 3. Department of Medicine, The Larner College of Medicine at The University of Vermont, 89 Beaumont Ave, Burlington, VT, 05405, USA. 4. Department of Pathology, The Larner College of Medicine at The University of Vermont, 360 South Park Drive, Colchester, VT, 05446, USA. 5. Department of Pediatrics, The Larner College of Medicine at The University of Vermont, 1 South Prospect Street, Burlington, VT, 05401, USA. 6. Department of Psychiatry, The Larner College of Medicine at The University of Vermont, 1 South Prospect Street, Burlington, VT, 05401, USA. 7. Department of Family Medicine, The Larner College of Medicine at The University of Vermont, 1 South Prospect Street, Burlington, VT, 05401, USA. 8. Department of Medicine, Maine Medical Center, Portland, Maine, 04102, USA.
Abstract
BACKGROUND: In response to the opioid epidemic, many states have enacted policies limiting opioid prescriptions. There is a paucity of evidence of the impact of opioid prescribing interventions in primary care populations, including whether unintended consequences arise from limiting the availability of prescribed opioids. OBJECTIVE: Our aim was to compare changes in opioid overdose and related adverse effects rate among primary care patients following the implementation of state-level prescribing policies. DESIGN: A cohort of primary care patients within an interrupted time series model. PARTICIPANTS: Electronic medical record data for 62,776 adult (18+ years) primary care patients from a major medical center in Vermont from January 1, 2016, to June 30, 2018. INTERVENTIONS: State-level opioid prescription policy changes limiting dose and duration. MAIN MEASURES: Changes in (1) opioid overdose rate and (2) opioid-related adverse effects rate per 100,000 person-months following the July 1, 2017, prescription policy change. KEY RESULTS: Among primary care patients, there was no change in opioid overdose rate following implementation of the prescribing policy (incidence rate ratio; IRR: 0.64, 95% confidence interval; CI: 0.22-1.88). There was a 78% decrease in the opioid-related adverse effects rate following the prescribing policy (IRR: 0.22, 95%CI: 0.09-0.51). This association was moderated by opioid prescription history, with decreases observed among opioid-naïve patients (IRR: 0.18, 95%CI: 0.06-0.59) and among patients receiving chronic opioid prescriptions (IRR: 0.17, 95%CI: 0.03-0.99), but not among those with intermittent opioid prescriptions (IRR: 0.51, 95%CI: 0.09-2.82). CONCLUSIONS: Limiting prescription opioids did not change the opioid overdose rate among primary care patients, but it reduced the rate of opioid-related adverse effects in the year following the state-level policy change, particularly among patients with chronic opioid prescription history and opioid-naïve patients. Limiting the quantity and duration of opioid prescriptions may have beneficial effects among primary care patients.
BACKGROUND: In response to the opioid epidemic, many states have enacted policies limiting opioid prescriptions. There is a paucity of evidence of the impact of opioid prescribing interventions in primary care populations, including whether unintended consequences arise from limiting the availability of prescribed opioids. OBJECTIVE: Our aim was to compare changes in opioid overdose and related adverse effects rate among primary care patients following the implementation of state-level prescribing policies. DESIGN: A cohort of primary care patients within an interrupted time series model. PARTICIPANTS: Electronic medical record data for 62,776 adult (18+ years) primary care patients from a major medical center in Vermont from January 1, 2016, to June 30, 2018. INTERVENTIONS: State-level opioid prescription policy changes limiting dose and duration. MAIN MEASURES: Changes in (1) opioid overdose rate and (2) opioid-related adverse effects rate per 100,000 person-months following the July 1, 2017, prescription policy change. KEY RESULTS: Among primary care patients, there was no change in opioid overdose rate following implementation of the prescribing policy (incidence rate ratio; IRR: 0.64, 95% confidence interval; CI: 0.22-1.88). There was a 78% decrease in the opioid-related adverse effects rate following the prescribing policy (IRR: 0.22, 95%CI: 0.09-0.51). This association was moderated by opioid prescription history, with decreases observed among opioid-naïve patients (IRR: 0.18, 95%CI: 0.06-0.59) and among patients receiving chronic opioid prescriptions (IRR: 0.17, 95%CI: 0.03-0.99), but not among those with intermittent opioid prescriptions (IRR: 0.51, 95%CI: 0.09-2.82). CONCLUSIONS: Limiting prescription opioids did not change the opioid overdose rate among primary care patients, but it reduced the rate of opioid-related adverse effects in the year following the state-level policy change, particularly among patients with chronic opioid prescription history and opioid-naïve patients. Limiting the quantity and duration of opioid prescriptions may have beneficial effects among primary care patients.
Authors: Laura G Burke; Xiner Zhou; Katherine L Boyle; E John Orav; Dana Bernson; Maria-Elena Hood; Thomas Land; Monica Bharel; Austin B Frakt Journal: Addiction Date: 2019-12-21 Impact factor: 6.526
Authors: Gwen Lapham; Denise M Boudreau; Eric A Johnson; Jennifer F Bobb; Abigail G Matthews; Jennifer McCormack; David Liu; Jeffrey H Samet; Andrew J Saxon; Cynthia I Campbell; Joseph E Glass; Rebecca C Rossom; Mark T Murphy; Ingrid A Binswanger; Bobbi Jo H Yarborough; Katharine A Bradley Journal: Drug Alcohol Depend Date: 2019-11-15 Impact factor: 4.492
Authors: Marsha A Raebel; Sophia R Newcomer; Liza M Reifler; Denise Boudreau; Thomas E Elliott; Lynn DeBar; Ameena Ahmed; Pamala A Pawloski; David Fisher; W Troy Donahoo; Elizabeth A Bayliss Journal: JAMA Date: 2013-10-02 Impact factor: 56.272
Authors: Gabriel A Brat; Denis Agniel; Andrew Beam; Brian Yorkgitis; Mark Bicket; Mark Homer; Kathe P Fox; Daniel B Knecht; Cheryl N McMahill-Walraven; Nathan Palmer; Isaac Kohane Journal: BMJ Date: 2018-01-17