Suchergebnisse

AbstractStates have responded to the opioid epidemic by implementing statewide prescription drug monitoring programs (PDMPs). By helping identify patients at "high risk" for suspected misuse, diversion, and doctor shopping, mandatory PDMPs aim to reduce prescription‐opioid misuse and related overdose mortality. So far, however, there is little research on whether prescribing declines following mandatory PDMP laws were targeted toward patient‐age groups with a higher incidence of prescription‐opioid misuse. To examine the heterogeneous impacts of state laws on different patient‐age groups, this study exploits the implementation of PDMP reforms in Kentucky starting July 20, 2012. The analysis uses novel data from PDMPs, including the universe of opioid prescriptions dispensed between January 2012 and November 2013. Individual prescriber‐level difference‐in‐differences, with Indiana as the control state, show that practitioners responded to Kentucky's new laws as expected, by prescribing opioids to fewer patients and authorizing fewer prescriptions and days of supply per prescription. Opioid prescribing declined most sharply to patient sub‐populations with the highest past incidence of prescription‐opioid‐involved overdose mortality—ages 25–54 years. Considering the implication for overdose mortality, we find that Kentucky's PDMP reform was associated with significant declines in prescription‐opioid overdose deaths, particularly among adolescents and younger adults (ages 15–34 years). However, the decline in prescription‐opioid‐involved mortality was offset by an increase in illicit‐drug mortality, resulting in no net change in total drug‐overdose mortality in Kentucky following its mandatory PDMP.

Objectives The misuse and abuse of prescription opioids (POs) is an epidemic in the USA today. Many states have implemented legislation to curb the use of POs resulting from inappropriate prescribing. Indiana legislated opioid prescribing rules that went into effect in December 2013. The rules changed how chronic pain is managed by healthcare providers. This qualitative study aims to evaluate the impact of Indiana's opioid prescription legislation on the patient experiences around pain management. Setting This is a qualitative study using interviews of patient and primary care providers to obtain triangulated data sources. The patients were recruited from an integrated pain clinic to which chronic pain patients were referred from federally qualified health clinics (FQHCs). The primacy care providers were recruited from the same FQHCs. The study used inductive, emergent thematic analysis. Participants Nine patient participants and five primary care providers were included in the study. Results Living with chronic pain is disruptive to patients' lives on multiple dimensions. The established pain management practices were disrupted by the change in prescription rules. Patient–provider relationships, which involve power dynamics and decision making, shifted significantly in parallel to the rule change. Conclusions As a result of the changes in pain management practice, some patients experienced significant challenges. Further studies into the magnitude of this change are necessary. In addition, exploring methods for regulating prescribing while assuring adequate access to pain management is crucial.