A new study finds that state laws aimed at curbing prescription opioid abuse have had no measurable effect on one of the most vulnerable populations with a high rate of use: Disabled people on Medicare.
Responding to a fourfold rise in death rates between 2006 and 2012, states collectively enacted 81 laws restricting prescribing and dispensing of prescription opioids, noted researchers from the Dartmouth Institute of Health Policy and Clinical Practice and University of California, Los Angeles (UCLA) School of Law.
“States hoped passing a range of laws might help,” said Jill Horwitz, Ph.D., JD. “So they are enacting small fixes — forbidding patients from ‘doctor-shopping’ and requiring doctors to use tamper-resistant prescription forms. They are also implementing major efforts, such as prescription drug monitoring programs (PDMPs), online databases that allow law enforcement and clinicians to monitor prescriptions.”
For their study, the researchers analyzed the effects of these laws on prescription opioid use in 2.2 million disabled Medicare beneficiaries between the ages of 21 to 64.
Their analysis revealed no significant association between state laws and hazardous prescribing patterns, such as very high daily opioid doses (equal to 120 mg or more of morphine) and the rate of nonfatal overdose.
States introducing multiple laws — three or more between 2006 and 2012 — experienced lower growth in the number of people receiving opioids from multiple prescribers, but the impact was small and not statistically significant, according to the researchers.
“We studied a particularly vulnerable population, disabled Medicare beneficiaries. They have higher rates of opioid use, poverty, and complex medical conditions compared to the general U.S. population,” said the study’s lead author, Dartmouth Institute Professor Ellen Meara, Ph.D.
“Because of their high rate of death from prescription opioid overdose, they could have benefited from effective regulation. However, the laws appear weak and slow relative to the epidemic they aim to curb.”
She noted that in 2008, death rates from prescription opioid overdose in the population studied were nearly 10 times the U.S. rate — 46.6 versus 4.8 per 100,000.
Laws strengthened since 2012 may have a bigger impact, according to the researchers. Since 2012, 20 states have begun to require prescribers to consult the PDMP before prescribing controlled substances to new patients. The researchers said they plan to examine that next.
“Successful prescription opioid regulation should strike the hard balance between controlling misuse and fostering compassionate pain management,” said Nancy Morden, M.D., senior author and a primary care physician. “Clinicians need to carefully consider their role in prescription opioid misuse and overdose.”
“Opioid abuse is a growing threat to public health. Prescription drug monitoring programs and other laws are costly,” Meara added. “Our findings indicate they don’t do much to curb opioid abuse or overdose, at least in this vulnerable population. States might invest more resources in evaluating the effectiveness of legislation.”
Source: The Dartmouth Institute
Image: Dr. Ellen Meara was the lead author on a study which found state laws aimed at curbing prescription opioid abuse appear to have no impact among disabled adults. Credit: The Dartmouth Institute.