Prescriber responses to a pain clinic law: Cease or modify?. (1st January 2020)

• Record Type: Journal Article
• Authors: Yenerall, Jackie; Buntin, Melinda B.
• Is Part Of: Drug and alcohol dependence. Volume 206(2020)
• Publication Date: 2020-01-01
• Subjects: Prescription opioids -- Pain clinic laws -- Policy analysis; Drug abuse -- Periodicals; Alcoholism -- Periodicals; 616.86
• DOI: 10.1016/j.drugalcdep.2019.107591
• Languages: English
• ISSNs: 0376-8716

Abstract

Highlights: Prescribers can respond to a pain clinic law by ceasing or modifying behavior. Past studies have not investigated response types despite patient implications. 35% of high-risk prescribers ceased prescribing in response to the pain clinic law. Prescription declines were nearly twice as larger in the cessation group. Abstract: Background: Pain clinic laws are designed to cease or modify high-risk prescribing behavior. However, prior evaluations have not differentiated between these types of prescriber responses in their analysis, even though they may have different implications for patients. The purpose of this analysis is to investigate the effect of a 2016 Tennessee pain clinic law on the two types of prescriber responses. Methods: We used data on opioid prescriptions from the Tennessee Controlled Substances Monitoring Database (CSMD) between July 1 st, 2015 and July 1 st, 2017. Prescribers were assigned to the cessation or modification group based on the date of their last opioid prescription during the time period July 1 st, 2015 to July 1 st, 2018 and its relationship to the change in law. A risk score was developed based on five indicators to capture two categories of risky prescriber behavior: increased risk for diversion or increased patient's risk of overdose. Within-prescriber differences were used to assess the effect of the law on several outcomes that capture the quantity and content of opioid prescriptions. Results: There was a significant decline in the number of prescriptions (cessation mean = −45.18 pval<0.001; continuation mean = −24.41 pval<0.001) and patients (cessation mean = −16.68pval<0.001; continuation mean = −10.92 pval<0.001) in both prescriber response groups, but the magnitude of decline was much larger in the cessation group. High-risk prescribers were more likely to cease prescribing than modify. Conclusions: Prescribers who ceased prescribing in response to the pain clinic law disproportionately contributed to overall declines in opioid prescriptions.