The effect of state laws designed to prevent nonmedical prescription opioid use on overdose deaths and treatment.

Nonmedical use of prescription opioids has reached epidemic levels in the United States and globally. In response, federal, state, and local governments are taking actions to address substantial increases in prescription opioid addiction and its associated harms. This study examines the effect of two state laws specifically designed to curtail access to prescription opioids to nonmedical users: pain management clinic and doctor shopping laws. We use administrative data on overdose deaths and admissions to specialty substance use disorder treatment coupled with a differences-in-differences design. Our findings suggest that both pain management clinic and doctor shopping laws have the potential to reduce prescription opioid overdose deaths. Moreover, doctor shopping laws appear to reduce prescription opioid treatment admissions. As many states have adopted these laws in recent years, the full effects of the laws may not yet be realized. Future research using more postlaw passage data should reevaluate the effectiveness of these laws.

The Management of Chronic Back Pain in Primary Care Settings: Exploring Perceived Facilitators and Barriers to the Development of Patient-Professional Partnerships.

Supporting patients in forming partnerships with health professionals is the key of effective self-management. This study aimed to explore the nature of patient-professional partnerships and its related factors that create facilitators and barriers to patients' self-management ability. A constructivist grounded theory approach was undertaken. Three main themes emerged: interaction and communication, integrated care, and service and system. A theoretical model was generated that posits effective communication, individualized integrated care, and high-quality service as key influences on the successful development of patient-professional partnerships and patients' ability to self-manage. Giving attention to these factors helps understand the development, implementation, mechanisms, and evaluation of building a patient-professional partnership and maximizes the opportunities for patient self-management of chronic pain. Future research and practice are needed to move beyond a simplistic focus on health outcomes to address the complex links between partnerships and treatment delivery processes, and interventions, effects, and patients' context.

State pain management clinic policies and county opioid prescribing: A fixed effects analysis.

BACKGROUND: The U.S. has seen an unprecedented rise in opioid-related morbidity and mortality, and states have passed numerous laws in response. Researchers have not comprehensively established the effectiveness of pain management clinic regulations to reduce opioid prescribing using national data. METHODS: We combine a policy dataset from the Prescription Drug Abuse Policy System with the Centers for Disease Control and Prevention county-level opioid prescribing data, as well as with numerous government datasets for county- and state- level covariates. We predict retail opioid prescriptions dispensed per 100 people using county fixed-effects models with a state-level cluster correction. Our key predictors of interest are the presence of any state-level pain management clinic law and eight specific subcomponents of the law. RESULTS: Pain management clinic laws demonstrate consistent, negative effects on prescribing rates. Controlling for county characteristics, state spending, and the broader policy context, states with pain management clinic laws had, on average, 5.78 fewer opioid prescriptions per 100 people than states without such laws (p < .05). Five specific subcomponents demonstrate efficacy in reducing prescribing rates: certification requirements (B = -6.02, p < .05), medical directors (B = -6.14, p < .05), dispenser and dispensing amount restrictions (B = -8.60, p < .01; B = -15.51, p < .001), and explicit penalties for noncompliance (B = -6.02, p < .05). Three subcomponents had no effect: prescription quantity restrictions and requirements to register with or review prescription drug monitoring programs. CONCLUSIONS: Implementation of pain management clinic laws reduced county-level opioid prescribing. States should review specific components to determine which forms of law are most efficacious.