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Drug laws not associated with reduction in harmful opioid use, overdose among disabled

The adoption of controlled-substance laws since 2006 was not associated with a decrease in potentially hazardous opioid use, or in the number of opioid overdoses, among disabled Medicare beneficiaries, according to data published in the New England Journal of Medicine.

“States have responded to rising rates of prescription-opioid overdose by adopting laws that restrict the prescribing and dispensing of controlled dangerous substances,” Ellen Meara, PhD, of the Dartmouth Institute for Health Policy and Clinical Practice, in Lebanon, New Hampshire, and colleagues wrote. “In 2010, after the adoption of many new controlled-substance restrictions, rates of prescription-opioid overdose dipped slightly before reaching a historic high in 2014. The relationship between legal restrictions and prescription-opioid use remains unclear, because previous research evaluated one or two laws, short time periods, or few states.”

To analyze the relationship between state restrictions on controlled substances and potentially harmful opioid use and overdoses, the researchers examined Medicare administrative data for fee-for-service disabled beneficiaries aged 21 to 64, who were alive throughout the calendar year, representing 8.7 million person-years from 2006 through 2012. For each calendar year during that period, the researchers created a cohort from a random 40% sample of all Medicare beneficiaries. They also analyzed an original data set of laws, including prescription drug monitoring programs.

The researchers examined the annual prevalence of beneficiaries with four or more opioid prescribers, prescriptions yielding a daily morphine-equivalent dose (MED) of more than 120 mg, and treatment for nonfatal overdose. In addition, they estimated how opioid outcomes varied according to eight types of laws.

According to the researchers, states added 81 controlled-substance laws from 2006 through 2012. However, they noted that opioid receipt and potentially harmful prescription patterns were common. For example, in 2012, 47% of beneficiaries filled opioid prescriptions, 8% had four or more opioid prescribers, 5% had prescriptions yielding a daily MED of more than 120 mg in any calendar quarter, and 0.3% were treated for a nonfatal prescription-opioid overdose.

In addition, the researchers reported no significant associations between opioid outcomes and specific types of laws, nor with the number of laws enacted. For example, the percentage of beneficiaries with a prescription yielding a daily MED of more than 120 mg did not decline after adoption of a prescription-drug monitoring program.

“Misuse of and overdose from opioid analgesics threaten public health,” Meara and colleagues wrote. “Yet we found that state laws that impose costly requirements on prescribers, pharmacists and patients did not have meaningful associations with opioid use or adverse outcomes, at least in the vulnerable population that we studied… Effective and safer alternatives for chronic pain management are needed, as is a comprehensive response to opioid addiction.” – by Jason Laday

Disclosure: Meara reports grant support from the NIH during the conduct of the study. See the full article for additional financial disclosures.