Effect of a “pill mill” law on opioid prescribing and utilization: The case of Texas

•We model the impact of Texas’s 2010 ‘pill mill’ law.•We examine changes in morphine equivalent dose (MED), opioid volume, and number of prescriptions and pills.•We report significant declines in the outcomes examined.•Declines are concentrated among high-risk patients and prescribers. States have a...

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Bibliographic Details
Published in:Drug and alcohol dependence Vol. 159; pp. 190 - 197
Main Authors: Lyapustina, Tatyana, Rutkow, Lainie, Chang, Hsien-Yen, Daubresse, Matthew, Ramji, Alim F., Faul, Mark, Stuart, Elizabeth A., Alexander, G. Caleb
Format: Journal Article
Language:English
Published: Ireland Elsevier Ireland Ltd 01.02.2016
Subjects:
Adult
Analgesics, Opioid - therapeutic use
Databases, Factual
Drug Utilization - legislation & jurisprudence
Drug Utilization - statistics & numerical data
Drug Utilization - trends
Female
Humans
Male
Middle Aged
Pill mill law
Prescription Drug Misuse - legislation & jurisprudence
Prescription drug monitoring
Prescription pain medication
Prescriptions - statistics & numerical data
Psychiatry
Texas
Time series analysis
Prescription drug monitoring
Prescription pain medication
Pill mill law
Time series analysis
ISSN:0376-8716, 1879-0046
Online Access:Get full text
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Summary:•We model the impact of Texas’s 2010 ‘pill mill’ law.•We examine changes in morphine equivalent dose (MED), opioid volume, and number of prescriptions and pills.•We report significant declines in the outcomes examined.•Declines are concentrated among high-risk patients and prescribers. States have attempted to reduce prescription opioid abuse through strengthening the regulation of pain management clinics; however, the effect of such measures remains unclear. We quantified the impact of Texas’s September 2010 “pill mill” law on opioid prescribing and utilization. We used the IMS Health LRx LifeLink database to examine anonymized, patient-level pharmacy claims for a closed cohort of individuals filling prescription opioids in Texas between September 2009 and August 2011. Our primary outcomes were derived at a monthly level and included: (1) average morphine equivalent dose (MED) per transaction; (2) aggregate opioid volume; (3) number of opioid prescriptions; and (4) quantity of opioid pills dispensed. We compared observed values with the counterfactual, which we estimated from pre-intervention levels and trends. Texas’s pill mill law was associated with declines in average MED per transaction (−0.57mg/month, 95% confidence interval [CI] −1.09, −0.057), monthly opioid volume (−9.99kg/month, CI −12.86, −7.11), monthly number of opioid prescriptions (−12,200 prescriptions/month, CI −15,300, −9,150) and monthly quantity of opioid pills dispensed (−714,000 pills/month, CI −877,000, −550,000). These reductions reflected decreases of 8.1–24.3% across the outcomes at one year compared with the counterfactual, and they were concentrated among prescribers and patients with the highest opioid prescribing and utilization at baseline. Following the implementation of Texas’s 2010 pill mill law, there were clinically significant reductions in opioid dose, volume, prescriptions and pills dispensed within the state, which were limited to individuals with higher levels of baseline opioid prescribing and utilization.
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ISSN:0376-8716
1879-0046
DOI:10.1016/j.drugalcdep.2015.12.025