A law banning physicians from dispensing certain strong opioids discouraged the doctors from prescribing those drugs at all, according to a new study, which also found that the doctors dispensed weaker nonsteroidal anti-inflammatory drugs (NSAIDS) and other medications to injured workers as a result.
The study, “The Impact of Physician Dispensing on Opioid Use,” from the Workers Compensation Research Institute (WCRI) sought to gauge the impact of Florida’s House Bill 7095, which went into effect on July 1, 2011. The so-called “Pill Mill Bill” was intended to control the overuse of opioids in Florida without interfering with the appropriate treatment of chronic pain, the study notes.
Given that intent, the authors of the study expected little change in the percentage of patients getting strong opioids; rather they expected only a change from physician-dispensed to pharmacy-dispensed. They actually found no material increase in pharmacy-dispensed strong opioids in their analysis of pain medications dispensed to injured workers.
Before the ban, 12.2 percent of injured workers received strong opioids dispensed from pharmacies within six months of their injuries; after the ban, the pharmacy-dispensed figure rose to only 12.5 percent.
Doctors have complied with the ban—as demonstrated by the fact that before the law took effect, 3.9 percent of injured workers got physician-dispensed strong opioids within the first six months after their injuries, compared to only 0.5 percent of those in the post-reform group. The study finds, however, that Florida doctors are now dispensing other, weaker drugs.
Comparing pre-reform and post-reform dispensing practices, the study authors note that there were jumps both in the percentage of patients receiving physician-dispensed nonsteroidal anti-inflammatory medications (e.g., ibuprofen)—from 24.1 percent to 25.8 percent within six months of injury—and in the percentage receiving weaker (not banned) opioids—rising from 9.1 percent to 10.1 percent.
What’s more, if the pre-ban strong opioids were necessary, researchers would expect that workers who received weaker physician-dispensed pain medications after the ban would later need strong opioids (that can be dispensed only at a pharmacy). But only 2 percent of those receiving weaker physician-dispensed pain medications in the first six months after the ban received stronger opioids at a pharmacy in the next six months.
A particularly compelling chart in the report shows the share of all physician-dispensed medications in various therapeutic classes (strong opioids, weaker opioids, NSAIDs, muscle relaxants, OTC pain meds) before and after reform. While strong opioids accounted for nearly 7 percent of physician-dispensed prescriptions before the law, the share was less than 1 percent post reform. On the other hand, NSAIDs made up 38.8 percent of the total before the reforms and jumped to 41.8 percent after.
Drawing from the Florida results, the study suggest a need for policymakers in other states to think about shifting the debate from one focused on the much higher prices charged by physician-dispensers than pharmacies for the same medications to one focused on whether physicians should be allowed to dispense certain drugs at all.
“When we compare pre- and post-reform prescribing practices, it appears that physician-dispensers not only reduced their dispensing of strong opioids but also reduced prescribing of strong opioids. This raises concerns that a significant proportion of pre-reform physician-dispensed strong opioids were not necessary, which means injured workers in Florida were put at greater risk for addiction, disability or work loss, and even death,” said Richard Victor, WCRI’s executive director. “Since Florida has banned physician dispensing of strong opioids, the lessons of this study are relevant for the other states concerned about eliminating unnecessary costs in their system while protecting injured workers from unnecessary medical care.”
About the Study
- The study analyzed data on the medications dispensed for injured workers covered by the Florida workers compensation program. It included both open and closed Florida claims.
- The claims were divided into two groups: pre-reform, with dates of injury from Jan. 1, 2010 to June 30, 2010 (prior to the July 1, 2011, effective date of the ban) and post-reform, with dates of injury from July 1, 2011 to Dec. 30, 2011 (immediately after the ban).
- The data included 24,567 claims with 59,564 prescriptions in the pre-reform group and 21,625 claims with 52,747 prescriptions in the post-reform group.
Source: Workers Compensation Research Institute