Influence of Opioid Prescription Policy on Overdoses and Related Adverse Effects in a Primary Care Population.
J Gen Intern Med
; 36(7): 2013-2020, 2021 07.
Article
em En
| MEDLINE
| ID: mdl-33948793
ABSTRACT
BACKGROUND:
In response to the opioid epidemic, many states have enacted policies limiting opioid prescriptions. There is a paucity of evidence of the impact of opioid prescribing interventions in primary care populations, including whether unintended consequences arise from limiting the availability of prescribed opioids.OBJECTIVE:
Our aim was to compare changes in opioid overdose and related adverse effects rate among primary care patients following the implementation of state-level prescribing policies.DESIGN:
A cohort of primary care patients within an interrupted time series model.PARTICIPANTS:
Electronic medical record data for 62,776 adult (18+ years) primary care patients from a major medical center in Vermont from January 1, 2016, to June 30, 2018.INTERVENTIONS:
State-level opioid prescription policy changes limiting dose and duration. MAINMEASURES:
Changes in (1) opioid overdose rate and (2) opioid-related adverse effects rate per 100,000 person-months following the July 1, 2017, prescription policy change. KEYRESULTS:
Among primary care patients, there was no change in opioid overdose rate following implementation of the prescribing policy (incidence rate ratio; IRR 0.64, 95% confidence interval; CI 0.22-1.88). There was a 78% decrease in the opioid-related adverse effects rate following the prescribing policy (IRR 0.22, 95%CI 0.09-0.51). This association was moderated by opioid prescription history, with decreases observed among opioid-naïve patients (IRR 0.18, 95%CI 0.06-0.59) and among patients receiving chronic opioid prescriptions (IRR 0.17, 95%CI 0.03-0.99), but not among those with intermittent opioid prescriptions (IRR 0.51, 95%CI 0.09-2.82).CONCLUSIONS:
Limiting prescription opioids did not change the opioid overdose rate among primary care patients, but it reduced the rate of opioid-related adverse effects in the year following the state-level policy change, particularly among patients with chronic opioid prescription history and opioid-naïve patients. Limiting the quantity and duration of opioid prescriptions may have beneficial effects among primary care patients.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Padrões de Prática Médica
/
Analgésicos Opioides
Tipo de estudo:
Prognostic_studies
Limite:
Adult
/
Humans
País/Região como assunto:
America do norte
Idioma:
En
Revista:
J Gen Intern Med
Assunto da revista:
MEDICINA INTERNA
Ano de publicação:
2021
Tipo de documento:
Article
País de afiliação:
Estados Unidos