title: Effect of a "pill mill" law on opioid prescribing and utilization: The case of Texas.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  Texas's pill mill law was associated with declines in average MED per transaction (-0.57 mg/month, 95% confidence interval [CI] -1.09, -0.057), monthly opioid volume (-9.99 kg/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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Johns Hopkins School of Medicine, 733 N Broadway, Baltimore, MD 21205, United States. Electronic address: tlyapus1@jhmi.edu.
authors.forename: Tatyana
authors.initials: T
authors.lastname: Lyapustina
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, 624 N. Broadway St., Baltimore, MD 21205, United States.
authors.forename: Lainie
authors.initials: L
authors.lastname: Rutkow
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, 624 N. Broadway St., Baltimore, MD 21205, United States.
authors.forename: Hsien-Yen
authors.initials: HY
authors.lastname: Chang
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, 615 N Wolfe St. W6027, Baltimore, MD 21205, United States; Johns Hopkins Bloomberg School of Public Health, Center for Drug Safety and Effectiveness, 615 N Wolfe St. W6035, Baltimore, MD 21205, United States.
authors.forename: Matthew
authors.initials: M
authors.lastname: Daubresse
authors.affiliation: Johns Hopkins School of Medicine, 733 N Broadway, Baltimore, MD 21205, United States.
authors.forename: Alim F
authors.initials: AF
authors.lastname: Ramji
authors.affiliation: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, 4770 Buford Hwy, NE Mail Stop MS F-63 Atlanta, GA 30341-3717, United States.
authors.forename: Mark
authors.initials: M
authors.lastname: Faul
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, 624 N. Broadway St., Baltimore, MD 21205, United States; Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, Hampton House, 624 N. Broadway, 8th Floor, Baltimore, MD 21205, United States; Johns Hopkins Bloomberg School of Public Health, Department of Biostatistics, 615 N. Wolfe St., Baltimore, MD 21205, United States.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Stuart
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, 615 N Wolfe St. W6027, Baltimore, MD 21205, United States; Johns Hopkins Bloomberg School of Public Health, Center for Drug Safety and Effectiveness, 615 N Wolfe St. W6035, Baltimore, MD 21205, United States; Johns Hopkins Medicine, Division of General Internal Medicine, 1800 Orleans St., Baltimore, MD 21287, United States.
authors.forename: G Caleb
authors.initials: GC
authors.lastname: Alexander
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D016208:Databases, Factual; D004363:Drug Utilization / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data* / Q000639:trends; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D063487:Prescription Drug Misuse / Q000331:legislation & jurisprudence*; D055656:Prescriptions / Q000706:statistics & numerical data*; D013781:Texas
chemical_list: D000701:Analgesics, Opioid
keywords: Pill mill law; Prescription drug monitoring; Prescription pain medication; Time series analysis