Effect of Florida's Prescription Drug Monitoring Program and Pill Mill Laws on Opioid Prescribing and Use.
OBJECTIVE
Prescription Drug Monitoring Program (PDMP) and pill mill laws are among the principal means states use to reduce prescription drug abuse and diversion, yet little high-quality evidence exists regarding their effect.


OBJECTIVE
To quantify the effect of Florida's PDMP and pill mill laws on overall and high-risk opioid prescribing and use.


METHODS
We applied comparative interrupted time-series analyses to IMS Health LifeLink LRx data to characterize the effect of PDMP and pill mill law implementation on a closed cohort of prescribers, retail pharmacies, and patients from July 2010 through September 2012 in Florida (intervention state) compared with Georgia (control state). We conducted sensitivity analyses, including varying length of observation and modifying requirements for continuous observation of individuals throughout the study period.


METHODS
Total opioid volume, mean morphine milligram equivalent (MME) per transaction, mean days' supply per transaction, and total number of opioid prescriptions dispensed. Analyses were conducted per prescriber and per patient, in aggregate and after stratifying by volume of baseline opioid prescribing for prescribers and use for patients.


RESULTS
From July 2010 through September 2012, a cohort of 2.6 million patients, 431,890 prescribers, and 2829 pharmacies was associated with approximately 480 million prescriptions in Florida and Georgia, 7.7% of which were for opioids. Total monthly opioid volume, MME per transaction, days' supply, and prescriptions dispensed were higher in Florida than Georgia before implementation. Florida's laws were associated with statistically significant declines in opioid volume (2.5 kg/mo, P<.05; equivalent to approximately 500,000 5-mg tablets of hydrocodone bitartrate per month) and MME per transaction (0.45 mg/mo, P<.05), without any change in days' supply. Twelve months after implementation, the policies were associated with approximately a 1.4% decrease in opioid prescriptions, 2.5% decrease in opioid volume, and 5.6% decrease in MME per transaction. Reductions were limited to prescribers and patients with the highest baseline opioid prescribing and use. Sensitivity analyses, varying time windows, and enrollment criteria supported the main results.


CONCLUSIONS
Florida's PDMP and pill mill laws were associated with modest decreases in opioid prescribing and use. Decreases were greatest among prescribers and patients with the highest baseline opioid prescribing and use.
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Lainie
L
Rutkow
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland2Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Hsien-Yen
HY
Chang
Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland3Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Matthew
M
Daubresse
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Daniel W
DW
Webster
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland2Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland4Department of Mental Health, Jo.
Elizabeth A
EA
Stuart
Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland3Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland6Division of General Internal Medicine, Johns Ho.
G Caleb
GC
Alexander
D000328:Adult; D000701:Analgesics, Opioid / Q000009:adverse effects*; D004335:Drug and Narcotic Control / Q000331:legislation & jurisprudence*; D017598:Efficiency, Organizational; D005260:Female; D005431:Florida / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D064226:Prescription Drug Diversion / Q000331:legislation & jurisprudence / Q000517:prevention & control; D063487:Prescription Drug Misuse / Q000706:statistics & numerical data*; D055553:Prescription Drugs / Q000009:adverse effects; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000517:prevention & control
D000701:Analgesics, Opioid; D055553:Prescription Drugs