Impact of Iowa’s Prescription Monitoring Program on Opioid Pain Reliever Prescribing Patterns: An Interrupted Time Series Study 2003–2014

Abstract Objective To evaluate the impact of Iowa’s prescription monitoring program (PMP), implemented in 2009, on opioid pain reliever (OPR) prescribing patterns. Methods We conducted interrupted time series analyses using 2003–2014 health insurance claims from a private health insurer in Iowa. OPR...

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Bibliographic Details
Published in:Pain medicine (Malden, Mass.) Mass.), 2019-02, Vol.20 (2), p.290-300
Main Authors: Ranapurwala, Shabbar I, Carnahan, Ryan M, Brown, Grant, Hinman, Jessica, Casteel, Carri
Format: Article
Language:English
Subjects:
Adult
Age
Aged
Analgesics
Analgesics, Opioid - therapeutic use
Beneficiaries
Dosage
Drug abuse
Female
Health
Health insurance
Health insurance industry
Humans
Insurance
Insurance companies
Insurance industry
Interrupted Time Series Analysis
Iowa
Male
Middle Aged
Morphine
Narcotics
Opioids
Pain
Practice Patterns, Physicians' - statistics & numerical data
Prescription Drug Monitoring Programs
Prescription writing
Prescriptions
Prescriptions (Drugs)
Retrospective Studies
Sex
Time series
Young Adult
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Summary:Abstract Objective To evaluate the impact of Iowa’s prescription monitoring program (PMP), implemented in 2009, on opioid pain reliever (OPR) prescribing patterns. Methods We conducted interrupted time series analyses using 2003–2014 health insurance claims from a private health insurer in Iowa. OPR prescriptions for all beneficiaries were included. Another data set included only OPR prescription for new opioid users required to have six months of insurance coverage. We evaluate four OPR prescribing patterns: 1) average daily dosage in morphine milligrams equivalents (MME), 2) MME per prescription, 3) average days’ supply per prescription, and 4) prescription rate per 1,000 insured person-years. We examined confounding and effect measure modification of the relationship between PMP and prescribing patterns by age and sex. Results During the 12 years of follow-up, 1,512,388 insured Iowans contributed 6,169,634.92 person-years of follow-up. Of these, 505,274 patients filled 2,401,818 OPR prescriptions and 360,688 new OPR users filled as many first OPR prescriptions. The increasing trend of OPR prescription rates from 2003 to 2009 declined post-PMP. Similarly, there was a large decline in MME per day and MME per prescription. The OPR days’ supply kept increasing post-PMP implementation, albeit at a slightly slower rate than pre-PMP implementation. There was no confounding by age and sex; however, we observed heterogeneity by age and sex; patients aged ≥50 years and females received higher doses and more prescriptions pre-PMP and experienced the greatest declines post-PMP. Conclusions Our study suggests that Iowa PMP implementation may have resulted in declines in OPR prescribing, and this impact varies by patient age and sex.
ISSN:1526-2375
1526-4637
DOI:10.1093/pm/pny029