Background: Pain management clinics are major sources of prescription opioids. Texas government passed several laws regulating pain clinics between 2009 and 2011 to reduce opioid-related toxicity. Understanding the impact of these laws can inform policy geared toward making the laws more effective in curbing the growing epidemic of opioid overdose, especially among the elderly population. Objectives: To examine the longitudinal association of laws regulating pain clinics on opioid-prescribing and opioid-related toxicity among Texas Medicare recipients. Methods: The 2007 to 2012 claims data for Texas Medicare Part D recipients were used to assess temporal trends in the percentage of patients filling any schedule II or schedule III opioid prescription, hospitalization for opioid toxicity, and their relationships to the 2009 to 2011 Texas laws regulating pain clinics. We excluded those with a cancer diagnosis. Join-point trend analysis with Bayesian Information Criterion selection methods were used to evaluate the change in monthly percentages of patients filling opioid prescriptions and hospitalization over time. Results: There was a short-lived decline in the monthly percentages of patients who filled a schedule II or schedule III opioid prescription after the 2009 laws regulating pain clinics. The decline lasted about 3 months. Subsequent new laws had no effect on the percentages of patients who filled any opioid prescription or were hospitalized for potential opioid toxicity. Hospitalizations for opioid toxicity were highest in the winter and lowest in the summer. Conclusions: Changes in the percentages of opioid-prescribing or opioid-related hospitalizations over time were not associated with laws regulating pain clinics.
HaegerichTMPaulozziLJMannsBJJonesCM.What we know, and don’t know, about the impact of state policy and systems-level interventions on prescription drug overdose. Drug Alcohol Depend. 2014;145:34-47.
US Department of Justice. Drug Enforcement Administration. Office of Diversion Control. Rescheduling of hydrocodone combination products from schedule III to schedule II. FR Doc. 2014-19922 Filed 8-21-14; 8:45 am. http://www.deadiversion.usdoj.gov/fed_regs/rules/2014/fr0822.htm. Accessed December 21, 2015.
4.
Center for Disease Control and Prevention. Menu of pain management clinic regulation. 2013. http://www.cdc.gov/phlp/docs/menu-pmcr.pdf. Published 2013. Accessed December 21, 2015.
5.
RutkowLChangHDaubresseMWebsterDWStuartEAAlexanderG.Effect of Florida’s Prescription Drug Monitoring Program and Pill Mill Laws on Opioid Prescribing and Use. JAMA Intern Med. 2015;175:1642-1649.
6.
FranklinGMMaiJTurnerJSullivanMWickizerTFulton-KehoeD.Bending the prescription opioid dosing and mortality curves: impact of the Washington State opioid dosing guideline. Am J Ind Med. 2012;55:325-331.
Center for Disease Control and Prevention, Office for State, Tribal, Local and Territorial Support, Public Health Law Program. State laws on prescription drug misuse and abuse. http://www.cdc.gov/phlp/publications/topic/prescription.html. Accessed December 21, 2015.
10.
KuoYFRajiMAChenNWHasanHGoodwinJS.Trend in opioid prescriptions among Part D Medicare recipients from 2007 to 2012. Am J Med. 2016;129:221.e21-e30.
11.
ChouRTurnerJADevineEB. The effectiveness and risks of long-term opioid therapy for chronic pain: a systematic review for a National Institute of Health Pathways to Prevention Workshop. Ann Intern Med. 2015;162:276-286.
12.
GomesTJuurlinkDYaoZ. Impact of legislation and a prescription monitoring program on the prevalence of potentially inappropriate prescriptions for monitored drugs in Ontario: a time series analysis. CMAJ Open. 2014;2(4):E256-E261.
13.
SurrattHO’GradyCKurtzS. Reductions in prescription opioid diversion following recent legislative interventions in Florida. Pharmacoepidemiol Drug Saf. 2014;23:314-320.
14.
JohnsonHPaulozziLPorucznikCMackKHerterB.Decline in drug overdose deaths after state policy changes—Florida, 2010-2012. MMWR Morb Mortal Wkly Rep. 2014;63(26):569-574.
15.
KuehnBM.CDC: major disparities in opioid prescribing among states: some states crack down on excess prescribing. JAMA. 2014;312:684-686.
16.
DunnKMSaundersKWRutterCM. Opioid prescriptions for chronic pain and overdose: a cohort study. Ann Intern Med. 2010;152:85-92.
17.
National Cancer Institute. Joinpoint Regression Program, Version 3.5. Bethesda, MD: Statistical Methodology and Applications Branch and Data Modeling Branch, Surveillance Research Program, National Cancer Institute; 2011.
PaulozziLJMackKAHockenberryJM.Vital signs: variation among States in prescribing of opioid pain relievers and benzodiazepines—United States, 2012. MMWR Morb Mortal Wkly Rep. 2014;63(26):563-568.
22.
PittsSRNiskaRWXuJBurtCW.National Hospital Ambulatory Medical Care Survey: 2006 emergency department summary. Natl Health Stat Report. 2008;(7):1-38.
23.
DavisJMSearlesVBSevertsonSGDartRCBucher-BartelsonB.Seasonal variation in suicidal behavior with prescription opioid medication. J Affect Disord. 2014;158:30-36.
24.
WhiteRAAzraelDPapadopoulosFCLambertGWMillerM.Does suicide have a stronger association with seasonality than sunlight?BMJ Open. 2015;5(6):e007403. doi:10.1136/bmjopen-2014-007403.
25.
VyssokiBKapustaNDPraschak-RiederNDorffnerGWilleitM.Direct effect of sunshine on suicide. JAMA Psychiatry. 2014;71:1231-1237.
