Pill Mill Laws Proven to Reduce Opioid Prescribing

Opioid prescribing in Florida moderately declined around the same time the state instituted pill mill laws and a Prescription Drug Monitoring Program (PDMP).

Through PDMPs, pharmacists can play an active role in identifying individuals who may be at risk for opioid abuse and misuse, Lainie Rutkow, JD, PhD, MPH, associate professor at the Johns Hopkins Bloomberg School of Public Health, told Pharmacy Times.

“PDMPs are an important tool for pharmacists because they provide information about individuals’ prescription drug history,” Dr. Rutkow said. “Using this information in combination with their professional knowledge and expertise, pharmacists may identify individuals who are at high risk for abuse or misuse of prescription opioids.”

Florida in particular saw prescription drug overdose deaths increase more than 80% from 2003 to 2009, Dr. Rutkow and co-authors highlighted in a recent study. Reacting to the rise in opioid-related addiction and overdose, the state instituted laws aimed at pill mills or “rogue” pain management clinics in 2010, establishing prescribing and dispensing recommendations while asking centers to register with the state and have a physician owner. Florida also started up a PDMP in September 2011.

While other studies have shown drops in drug-related overdoses with these measures, the current researchers maintained that their study was unique in that it looked at how Florida’s measures could affect opioid prescribing.

Georgia served as a control state in the study because it had not implemented a pill mill law or PDMP in the examined period between 2010 and 2012.

After tracking 2829 pharmacies, 431,890 prescribers, and 2.6 million patients in Florida and Georgia from July 2010 to September 2012, the researchers determined that there were about 480 million total prescriptions written, nearly 8% of which were for opioids.

Roughly 77% of the prescriptions analyzed were filled at chain stores, while dispensing at independent retailers (9.9%), food stores (9%), and mass merchandisers (3.7%) was less common.

Prior to the Sunshine State’s efforts to curb opioid abuse, opioid volume on a monthly basis, average morphine milligram equivalent (MME) per transaction, days’ supply, and dispensed prescriptions were higher in Florida than Georgia.

One year after the control measures took effect, there was a 1.4% decrease in opioid prescriptions, a 2.5% decrease in opioid volume, and a 5.6% decrease in MME per transaction. These decreases were most significant among prescribers and patients with the highest baseline opioid prescribing and use, the researchers found.

By comparison, Georgia also saw decreases in these areas, but they were not as high as Florida’s. Total opioid volume decreased 2.3% in Georgia, while the average MME per transaction decreased 4.7%.

Although the average monthly MME per transaction in Florida increased from July 2010 through June 2011, it decreased about 36% from October 2011 to September 2012, the researchers found.

“Comparatively, decreases in Georgia’s monthly total MME per transaction during this period were negligible,” they stated.

All in all, Florida’s opioid-related policy changes were associated with prescribers in the 99th percentile of total opioid volume at baseline lowering their prescribing volume by around 600,000 5-mg hydrocodone bitartrate tablets per month.

“Our results are important given soaring rates of prescription opioid abuse, as well as the prominent role that laws have in shaping states’ responses to the epidemic,” the researchers concluded.

Their results were published in JAMA Internal Medicine.