"This study provides evidence that is consistent with patients of physician dispensers receiving more opioids than necessary," says the report from the Workers Compensation Research Institute. "If this evidence is correct, it would shift the policy debate from whether or not there are substantial benefits to some patients from physician dispensing to whether or not there is substantial harm to some patients from physician dispensing."
Florida implemented H.B. 7095 in July 2011 in an effort to control the overuse of opioids in the state without interfering with the appropriate treatment of chronic pain, according to the study. Under the new law, physicians are prohibited from dispensing Schedule II and Schedule III opioids but can continue to prescribe them as long as they are filled at a pharmacy.
For the study, Impact of Banning Physician Dispensing of Opioids in Florida, the researchers examined the medical care received by injured workers with injuries occurring prior to the law change and after the law change. Patients' prescription histories were examined for the first three to six months after the injury. While the organization points out the results are not definitive, they raise the possibility that economic incentives may lead some physicians to prescribe and dispense unnecessary medications.
The researchers reported the following findings:
- Physicians showed a high level of compliance with the new law. Where 3.5 percent of injured workers received strong opioids directly from physicians' offices prior to the reforms, the percentage dropped to just 0.5 percent after the ban.
- The ban reduced the overall likelihood that a prescription for strong opioids was filled. Prior to the reforms, 26.7 percent of all pain medication prescriptions were for strong opioids; the percentage dropped to 22.6 percent after the ban.
- Physician dispensers, on average, increased their use of less addictive pain medications such as ibuprofen and tramadol. The percentage of patients receiving physician-dispensed,other pain medications increased from 23.8 percent to 26 percent for nonsteroidal anti-inflammatory drugs and from 9 percent to 9.8 percent for weaker opioids they may still dispense.
"The physician dispensers could have continued to prescribe the stronger opioids (e.g., hydrocodone acetaminophen) but would have been required to send the patients to pharmacies," WCRI said in a statement. "This study reports no material change in the percentage of patients who received stronger opioids from pharmacies."
Among the questions raised by the researchers was whether physicians had prescribed and dispensed medications they deemed to be medically necessary for their patients before the ban took effect. "If all pre-ban physician-dispensed opioid prescriptions were necessary, we would expect prescribing patterns of physician dispensers to be unaffected by the ban ? only the opioid prescriptions would be filled at pharmacies rather than the physicians' offices," they wrote. "The data suggest that physician dispensers often changed prescribing practices from the strong opioids that were subjected to the physician-dispensing ban to non-opioid pain medications or weaker opioids that were not subject to the ban."
The organization said it plans an additional study that looks at patients "at a greater length of time from injury to provide more definitive information."
By Nancy Grover
Read more at the WorkersComp Forum homepage.
August 19, 2013
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