A Longitudinal Multivariable Analysis: State Policies and Opioid Dispensing in Medicare Beneficiaries Undergoing Surgery
Background States have implemented policies to decrease clinically unnecessary opioid prescribing, but few studies have examined how state policies affect opioid dispensing rate trends for surgical patients. Objective To examine trends in the perioperative opioid dispensing rates for fee-for-service...
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| Veröffentlicht in: | Journal of general internal medicine : JGIM 2024-11, Vol.39 (15), p.2942-2951 |
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| creator | Priest, Kelsey C. Merlin, Jessica S. Lai, Julie Sorbero, Mark Taylor, Erin A. Dick, Andrew W. Stein, Bradley D. |
| description | Background
States have implemented policies to decrease clinically unnecessary opioid prescribing, but few studies have examined how state policies affect opioid dispensing rate trends for surgical patients.
Objective
To examine trends in the perioperative opioid dispensing rates for fee-for-service Medicare beneficiaries and the effects of select state policies.
Design and Participants
A retrospective cohort study using 2006 to 2018 Medicare claims data for individuals undergoing surgical procedures for which opioid analgesic treatment is common.
Exposures
State policies mandating prescription drug monitoring program (PDMP; PDMP policies) use, initial opioid prescription duration limit (duration limit policies), and mandated continuing medical education (CME; CME pain policies) on pain management.
Main Measures
Opioid dispensing rates, days’ supply, and the daily morphine milligram equivalent dose (MMED).
Key Results
The percentage of Medicare beneficiaries dispensed opioids in the perioperative period increased from 2007 to 2018; MMED and days’ supply decreased over the same period, with significant variation by age, sex, and race. None of the three state policies affected the likelihood of Medicare beneficiaries being dispensed perioperative opioids. However, CME pain policies and duration limit policies were associated with decreased days’ supply and decreased MMED in the several years following implementation, respectively.
Conclusion
While we observed a slight increase in the rate of Medicare beneficiaries dispensed opioids perioperatively and a substantial decrease in MMED and days’ supply for those receiving opioids, state policies examined had relatively modest effects on the main measures. Our findings suggest that these state policies may have a limited impact on opioid dispensing for a patient population that is commonly dispensed opioid analgesics to help control surgical pain, and as a result may have little direct effect on clinical outcomes for this population. Changes in opioid dispensing for this population may be the result of broader societal trends than such state policies. |
| doi_str_mv | 10.1007/s11606-024-08888-3 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_3082308575</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3130567008</sourcerecordid><originalsourceid>FETCH-LOGICAL-c256t-daca9516ac32867383d2c7d14b8ff034e6ca01a19e5d45cc5bb53dc43ad6b5f43</originalsourceid><addsrcrecordid>eNp9kV1LHDEUhkOp1FX7B7wogd70ZurJ10y2d6vVVlhRUK9DJjmzRGYz22SmdP-90bUWemFuAifPeQPvQ8gxg68MoDnJjNVQV8BlBbqcSrwjM6a4qpicN-_JrExlpRsh98lBzg8ATHCuP5B9MQcOXMCM_FnQ5RBXYZx8iLanV1M_ht82Bdv2SBdltM0hf6O3ox2R3gx9cAEztdHT600YgqffQ95gzCGuaIj0Cn1wNiE9xYhdgUtU4e-jx7QanqDbKa0wbY_IXmf7jB9f7kNyf3F-d_azWl7_uDxbLCvHVT1W3jo7V6y2TnBdN0ILz13jmWx114GQWDsLzLI5Ki-Vc6ptlfBOCuvrVnVSHJIvu9xNGn5NmEezDtlh39uIw5SNAF2K0KpRBf38H_owTKlUUCgmQNUNgC4U31EuDTkn7MwmhbVNW8PAPHkxOy-meDHPXowoS59eoqd2jf515a-IAogdkMtTLAX9-_uN2Edsl5mh</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3130567008</pqid></control><display><type>article</type><title>A Longitudinal Multivariable Analysis: State Policies and Opioid Dispensing in Medicare Beneficiaries Undergoing Surgery</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><creator>Priest, Kelsey C. ; Merlin, Jessica S. ; Lai, Julie ; Sorbero, Mark ; Taylor, Erin A. ; Dick, Andrew W. ; Stein, Bradley D.</creator><creatorcontrib>Priest, Kelsey C. ; Merlin, Jessica S. ; Lai, Julie ; Sorbero, Mark ; Taylor, Erin A. ; Dick, Andrew W. ; Stein, Bradley D.</creatorcontrib><description>Background
States have implemented policies to decrease clinically unnecessary opioid prescribing, but few studies have examined how state policies affect opioid dispensing rate trends for surgical patients.
Objective
To examine trends in the perioperative opioid dispensing rates for fee-for-service Medicare beneficiaries and the effects of select state policies.
Design and Participants
A retrospective cohort study using 2006 to 2018 Medicare claims data for individuals undergoing surgical procedures for which opioid analgesic treatment is common.
Exposures
State policies mandating prescription drug monitoring program (PDMP; PDMP policies) use, initial opioid prescription duration limit (duration limit policies), and mandated continuing medical education (CME; CME pain policies) on pain management.
Main Measures
Opioid dispensing rates, days’ supply, and the daily morphine milligram equivalent dose (MMED).
Key Results
The percentage of Medicare beneficiaries dispensed opioids in the perioperative period increased from 2007 to 2018; MMED and days’ supply decreased over the same period, with significant variation by age, sex, and race. None of the three state policies affected the likelihood of Medicare beneficiaries being dispensed perioperative opioids. However, CME pain policies and duration limit policies were associated with decreased days’ supply and decreased MMED in the several years following implementation, respectively.
Conclusion
While we observed a slight increase in the rate of Medicare beneficiaries dispensed opioids perioperatively and a substantial decrease in MMED and days’ supply for those receiving opioids, state policies examined had relatively modest effects on the main measures. Our findings suggest that these state policies may have a limited impact on opioid dispensing for a patient population that is commonly dispensed opioid analgesics to help control surgical pain, and as a result may have little direct effect on clinical outcomes for this population. Changes in opioid dispensing for this population may be the result of broader societal trends than such state policies.</description><identifier>ISSN: 0884-8734</identifier><identifier>ISSN: 1525-1497</identifier><identifier>EISSN: 1525-1497</identifier><identifier>DOI: 10.1007/s11606-024-08888-3</identifier><identifier>PMID: 39020230</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Aged ; Aged, 80 and over ; Analgesics ; Analgesics, Opioid - supply & distribution ; Analgesics, Opioid - therapeutic use ; Beneficiaries ; Dispensing ; Drug development ; Drug Prescriptions - statistics & numerical data ; Female ; Government programs ; Health care policy ; Health Policy ; Humans ; Internal Medicine ; Longitudinal Studies ; Male ; Medicare ; Medicine ; Medicine & Public Health ; Morphine ; Narcotics ; Opioids ; Original Research ; Pain ; Pain management ; Pain Management - methods ; Pain Management - statistics & numerical data ; Pain Management - trends ; Pain, Postoperative - drug therapy ; Patients ; Perioperative care ; Policies ; Practice Patterns, Physicians' - statistics & numerical data ; Practice Patterns, Physicians' - trends ; Prescription Drug Monitoring Programs - trends ; Public health ; Retrospective Studies ; State policies ; Surgical equipment ; Trends ; United States</subject><ispartof>Journal of general internal medicine : JGIM, 2024-11, Vol.39 (15), p.2942-2951</ispartof><rights>The Author(s), under exclusive licence to Society of General Internal Medicine 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2024. The Author(s), under exclusive licence to Society of General Internal Medicine.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c256t-daca9516ac32867383d2c7d14b8ff034e6ca01a19e5d45cc5bb53dc43ad6b5f43</cites><orcidid>0000-0003-3207-4875 ; 0000-0003-1544-458X ; 0000-0001-9318-7748 ; 0000-0002-7819-1551 ; 0000-0003-3929-8177 ; 0000-0002-8122-5732</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s11606-024-08888-3$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s11606-024-08888-3$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27903,27904,41467,42536,51297</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39020230$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Priest, Kelsey C.</creatorcontrib><creatorcontrib>Merlin, Jessica S.</creatorcontrib><creatorcontrib>Lai, Julie</creatorcontrib><creatorcontrib>Sorbero, Mark</creatorcontrib><creatorcontrib>Taylor, Erin A.</creatorcontrib><creatorcontrib>Dick, Andrew W.</creatorcontrib><creatorcontrib>Stein, Bradley D.</creatorcontrib><title>A Longitudinal Multivariable Analysis: State Policies and Opioid Dispensing in Medicare Beneficiaries Undergoing Surgery</title><title>Journal of general internal medicine : JGIM</title><addtitle>J GEN INTERN MED</addtitle><addtitle>J Gen Intern Med</addtitle><description>Background
States have implemented policies to decrease clinically unnecessary opioid prescribing, but few studies have examined how state policies affect opioid dispensing rate trends for surgical patients.
Objective
To examine trends in the perioperative opioid dispensing rates for fee-for-service Medicare beneficiaries and the effects of select state policies.
Design and Participants
A retrospective cohort study using 2006 to 2018 Medicare claims data for individuals undergoing surgical procedures for which opioid analgesic treatment is common.
Exposures
State policies mandating prescription drug monitoring program (PDMP; PDMP policies) use, initial opioid prescription duration limit (duration limit policies), and mandated continuing medical education (CME; CME pain policies) on pain management.
Main Measures
Opioid dispensing rates, days’ supply, and the daily morphine milligram equivalent dose (MMED).
Key Results
The percentage of Medicare beneficiaries dispensed opioids in the perioperative period increased from 2007 to 2018; MMED and days’ supply decreased over the same period, with significant variation by age, sex, and race. None of the three state policies affected the likelihood of Medicare beneficiaries being dispensed perioperative opioids. However, CME pain policies and duration limit policies were associated with decreased days’ supply and decreased MMED in the several years following implementation, respectively.
Conclusion
While we observed a slight increase in the rate of Medicare beneficiaries dispensed opioids perioperatively and a substantial decrease in MMED and days’ supply for those receiving opioids, state policies examined had relatively modest effects on the main measures. Our findings suggest that these state policies may have a limited impact on opioid dispensing for a patient population that is commonly dispensed opioid analgesics to help control surgical pain, and as a result may have little direct effect on clinical outcomes for this population. Changes in opioid dispensing for this population may be the result of broader societal trends than such state policies.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Analgesics</subject><subject>Analgesics, Opioid - supply & distribution</subject><subject>Analgesics, Opioid - therapeutic use</subject><subject>Beneficiaries</subject><subject>Dispensing</subject><subject>Drug development</subject><subject>Drug Prescriptions - statistics & numerical data</subject><subject>Female</subject><subject>Government programs</subject><subject>Health care policy</subject><subject>Health Policy</subject><subject>Humans</subject><subject>Internal Medicine</subject><subject>Longitudinal Studies</subject><subject>Male</subject><subject>Medicare</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Morphine</subject><subject>Narcotics</subject><subject>Opioids</subject><subject>Original Research</subject><subject>Pain</subject><subject>Pain management</subject><subject>Pain Management - methods</subject><subject>Pain Management - statistics & numerical data</subject><subject>Pain Management - trends</subject><subject>Pain, Postoperative - drug therapy</subject><subject>Patients</subject><subject>Perioperative care</subject><subject>Policies</subject><subject>Practice Patterns, Physicians' - statistics & numerical data</subject><subject>Practice Patterns, Physicians' - trends</subject><subject>Prescription Drug Monitoring Programs - trends</subject><subject>Public health</subject><subject>Retrospective Studies</subject><subject>State policies</subject><subject>Surgical equipment</subject><subject>Trends</subject><subject>United States</subject><issn>0884-8734</issn><issn>1525-1497</issn><issn>1525-1497</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kV1LHDEUhkOp1FX7B7wogd70ZurJ10y2d6vVVlhRUK9DJjmzRGYz22SmdP-90bUWemFuAifPeQPvQ8gxg68MoDnJjNVQV8BlBbqcSrwjM6a4qpicN-_JrExlpRsh98lBzg8ATHCuP5B9MQcOXMCM_FnQ5RBXYZx8iLanV1M_ht82Bdv2SBdltM0hf6O3ox2R3gx9cAEztdHT600YgqffQ95gzCGuaIj0Cn1wNiE9xYhdgUtU4e-jx7QanqDbKa0wbY_IXmf7jB9f7kNyf3F-d_azWl7_uDxbLCvHVT1W3jo7V6y2TnBdN0ILz13jmWx114GQWDsLzLI5Ki-Vc6ptlfBOCuvrVnVSHJIvu9xNGn5NmEezDtlh39uIw5SNAF2K0KpRBf38H_owTKlUUCgmQNUNgC4U31EuDTkn7MwmhbVNW8PAPHkxOy-meDHPXowoS59eoqd2jf515a-IAogdkMtTLAX9-_uN2Edsl5mh</recordid><startdate>20241101</startdate><enddate>20241101</enddate><creator>Priest, Kelsey C.</creator><creator>Merlin, Jessica S.</creator><creator>Lai, Julie</creator><creator>Sorbero, Mark</creator><creator>Taylor, Erin A.</creator><creator>Dick, Andrew W.</creator><creator>Stein, Bradley D.</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QL</scope><scope>7U9</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>NAPCQ</scope><scope>P64</scope><scope>RC3</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-3207-4875</orcidid><orcidid>https://orcid.org/0000-0003-1544-458X</orcidid><orcidid>https://orcid.org/0000-0001-9318-7748</orcidid><orcidid>https://orcid.org/0000-0002-7819-1551</orcidid><orcidid>https://orcid.org/0000-0003-3929-8177</orcidid><orcidid>https://orcid.org/0000-0002-8122-5732</orcidid></search><sort><creationdate>20241101</creationdate><title>A Longitudinal Multivariable Analysis: State Policies and Opioid Dispensing in Medicare Beneficiaries Undergoing Surgery</title><author>Priest, Kelsey C. ; Merlin, Jessica S. ; Lai, Julie ; Sorbero, Mark ; Taylor, Erin A. ; Dick, Andrew W. ; Stein, Bradley D.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c256t-daca9516ac32867383d2c7d14b8ff034e6ca01a19e5d45cc5bb53dc43ad6b5f43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Analgesics</topic><topic>Analgesics, Opioid - supply & distribution</topic><topic>Analgesics, Opioid - therapeutic use</topic><topic>Beneficiaries</topic><topic>Dispensing</topic><topic>Drug development</topic><topic>Drug Prescriptions - statistics & numerical data</topic><topic>Female</topic><topic>Government programs</topic><topic>Health care policy</topic><topic>Health Policy</topic><topic>Humans</topic><topic>Internal Medicine</topic><topic>Longitudinal Studies</topic><topic>Male</topic><topic>Medicare</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Morphine</topic><topic>Narcotics</topic><topic>Opioids</topic><topic>Original Research</topic><topic>Pain</topic><topic>Pain management</topic><topic>Pain Management - methods</topic><topic>Pain Management - statistics & numerical data</topic><topic>Pain Management - trends</topic><topic>Pain, Postoperative - drug therapy</topic><topic>Patients</topic><topic>Perioperative care</topic><topic>Policies</topic><topic>Practice Patterns, Physicians' - statistics & numerical data</topic><topic>Practice Patterns, Physicians' - trends</topic><topic>Prescription Drug Monitoring Programs - trends</topic><topic>Public health</topic><topic>Retrospective Studies</topic><topic>State policies</topic><topic>Surgical equipment</topic><topic>Trends</topic><topic>United States</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Priest, Kelsey C.</creatorcontrib><creatorcontrib>Merlin, Jessica S.</creatorcontrib><creatorcontrib>Lai, Julie</creatorcontrib><creatorcontrib>Sorbero, Mark</creatorcontrib><creatorcontrib>Taylor, Erin A.</creatorcontrib><creatorcontrib>Dick, Andrew W.</creatorcontrib><creatorcontrib>Stein, Bradley D.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Virology and AIDS Abstracts</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of general internal medicine : JGIM</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Priest, Kelsey C.</au><au>Merlin, Jessica S.</au><au>Lai, Julie</au><au>Sorbero, Mark</au><au>Taylor, Erin A.</au><au>Dick, Andrew W.</au><au>Stein, Bradley D.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A Longitudinal Multivariable Analysis: State Policies and Opioid Dispensing in Medicare Beneficiaries Undergoing Surgery</atitle><jtitle>Journal of general internal medicine : JGIM</jtitle><stitle>J GEN INTERN MED</stitle><addtitle>J Gen Intern Med</addtitle><date>2024-11-01</date><risdate>2024</risdate><volume>39</volume><issue>15</issue><spage>2942</spage><epage>2951</epage><pages>2942-2951</pages><issn>0884-8734</issn><issn>1525-1497</issn><eissn>1525-1497</eissn><abstract>Background
States have implemented policies to decrease clinically unnecessary opioid prescribing, but few studies have examined how state policies affect opioid dispensing rate trends for surgical patients.
Objective
To examine trends in the perioperative opioid dispensing rates for fee-for-service Medicare beneficiaries and the effects of select state policies.
Design and Participants
A retrospective cohort study using 2006 to 2018 Medicare claims data for individuals undergoing surgical procedures for which opioid analgesic treatment is common.
Exposures
State policies mandating prescription drug monitoring program (PDMP; PDMP policies) use, initial opioid prescription duration limit (duration limit policies), and mandated continuing medical education (CME; CME pain policies) on pain management.
Main Measures
Opioid dispensing rates, days’ supply, and the daily morphine milligram equivalent dose (MMED).
Key Results
The percentage of Medicare beneficiaries dispensed opioids in the perioperative period increased from 2007 to 2018; MMED and days’ supply decreased over the same period, with significant variation by age, sex, and race. None of the three state policies affected the likelihood of Medicare beneficiaries being dispensed perioperative opioids. However, CME pain policies and duration limit policies were associated with decreased days’ supply and decreased MMED in the several years following implementation, respectively.
Conclusion
While we observed a slight increase in the rate of Medicare beneficiaries dispensed opioids perioperatively and a substantial decrease in MMED and days’ supply for those receiving opioids, state policies examined had relatively modest effects on the main measures. Our findings suggest that these state policies may have a limited impact on opioid dispensing for a patient population that is commonly dispensed opioid analgesics to help control surgical pain, and as a result may have little direct effect on clinical outcomes for this population. Changes in opioid dispensing for this population may be the result of broader societal trends than such state policies.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>39020230</pmid><doi>10.1007/s11606-024-08888-3</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0003-3207-4875</orcidid><orcidid>https://orcid.org/0000-0003-1544-458X</orcidid><orcidid>https://orcid.org/0000-0001-9318-7748</orcidid><orcidid>https://orcid.org/0000-0002-7819-1551</orcidid><orcidid>https://orcid.org/0000-0003-3929-8177</orcidid><orcidid>https://orcid.org/0000-0002-8122-5732</orcidid></addata></record> |
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| ispartof | Journal of general internal medicine : JGIM, 2024-11, Vol.39 (15), p.2942-2951 |
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| subjects | Aged Aged, 80 and over Analgesics Analgesics, Opioid - supply & distribution Analgesics, Opioid - therapeutic use Beneficiaries Dispensing Drug development Drug Prescriptions - statistics & numerical data Female Government programs Health care policy Health Policy Humans Internal Medicine Longitudinal Studies Male Medicare Medicine Medicine & Public Health Morphine Narcotics Opioids Original Research Pain Pain management Pain Management - methods Pain Management - statistics & numerical data Pain Management - trends Pain, Postoperative - drug therapy Patients Perioperative care Policies Practice Patterns, Physicians' - statistics & numerical data Practice Patterns, Physicians' - trends Prescription Drug Monitoring Programs - trends Public health Retrospective Studies State policies Surgical equipment Trends United States |
| title | A Longitudinal Multivariable Analysis: State Policies and Opioid Dispensing in Medicare Beneficiaries Undergoing Surgery |
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