Limits on opioid prescribing didn't change overdoses, but did reduce adverse effects
A study of primary care patients analyzed the effects of a Vermont policy that limited the dose and duration of opioid prescriptions based on pain severity and required prescription drug monitoring program checks.
Limiting prescription opioids did not change the opioid overdose rate among primary care patients but did reduce the rate of opioid-related adverse effects in the year after the state-level policy changes, particularly among patients who had a history of long-term opioid prescriptions and those who were opioid-naive, a study found.
Researchers sought to identify effects on opioid overdoses and adverse effects after the state of Vermont limited dose and duration of opioid prescriptions. Vermont's policy limited prescriptions based on pain severity and required prescription drug monitoring program checks.
Researchers collected data for 62,776 adult primary care patients at a major medical center from January 2016 to June 2018 to track the effects of the July 1, 2017, prescription policy change. Study results were published May 4 by the Journal of General Internal Medicine.
The study did not find a significant change in opioid overdose rates per 100,000 person-months following the policy change (incidence rate ratio [IRR], 0.64; 95% CI, 0.22 to 1.88). However, there was a 78% decrease in opioid-related adverse effects (IRR, 0.22; 95% CI, 0.09 to 0.51). This association was moderated by opioid prescription history, with significant decreases observed among opioid-naive patients (IRR, 0.18; 95% CI, 0.06 to 0.59) and among patients receiving long-term opioid prescriptions (IRR, 0.17; 95% CI, 0.03 to 0.99), but not among those with intermittent opioid prescriptions (IRR, 0.51; 95% CI, 0.09 to 2.82).
The study authors concluded that limiting the quantity and duration of opioid prescriptions may help primary care patients and that opioid-naive primary care patients and those with a history of long-term opioid prescriptions experienced the most dramatic reduction of opioid-related adverse effects.
“This finding may help assuage concerns among primary care practitioners that limiting prescription opioids will result in more illicit opioid use and overdoses,” the authors wrote. “Our results showing decreased adverse effects rate following the policy change are consistent with other studies reporting decreased prescribing following similar policy changes in the Eastern USA.”