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State Medical Board Policy and Opioid Prescribing: A Controlled Interrupted Time Series
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3 2021
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Source: Am J Prev Med. 60(3):343-351
[PDF-521.38 KB]
Details:
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Alternative Title:Am J Prev Med
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Personal Author:
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Description:Introduction:
In March 2016, the Centers for Disease Control and prevention issued opioid prescribing guidelines for chronic non-cancer pain. In response, in April 2016 the North Carolina Medical Board launched the Safe Opioid Prescribing Initiative, an investigative program intended to limit overprescribing of opioids. This study focuses on the association of the Safe Opioid Prescribing Initiative with immediate and sustained changes in opioid prescribing among all opioid patients, and opioid discontinuation and tapering among high-dose (>90 milligrams of morphine equivalents), long-term (>90 days) opioid therapy patients.
Methods:
Controlled and single interrupted time series analysis of opioid prescribing outcomes before and after the implementation of Safe Opioid Prescribing Initiative was conducted, using de-identified data from the North Carolina Controlled Substances Reporting System from January 2010 through March 2017. Analysis was conducted in 2019–2020.
Results:
In an average study month, 513,717 patients, including 47,842 high-dose, long-term opioid therapy patients, received 660,912 opioid prescriptions at 1.3 prescriptions per patient. There was a 0.52% absolute decline (95% CI= −0.87, −0.19) in patients receiving opioid prescriptions in the month after Safe Opioid Prescribing Initiative implementation. Abrupt discontinuation, rapid tapering, and gradual tapering of opioids among high-dose, long-term opioid therapy patients increased by 1% (95% CI= −0.22, 2.23), 2.2% (95% CI=0.91, 3.47), and 1.3% (95% CI=0.96, 1.57), respectively, in the month following Safe Opioid Prescribing Initiative implementation.
Conclusions:
Although Safe Opioid Prescribing Initiative implementation was associated with an immediate decline in overall opioid prescribing, it was also associated with an unintended immediate increase in discontinuations and rapid tapering among high-dose, long-term opioid therapy patients. Better policy communication and prescriber education regarding opioid tapering best practices may help mitigate unintended consequences of statewide policies.
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Pubmed ID:33309449
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Pubmed Central ID:PMC7902466
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Volume:60
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Issue:3
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