104 Intended and unintended consequences of a state policy to combat opioid over-prescribing among patients receiving high dose long term opioid therapy

Abstract

Statement of Purpose In May 2016, the North Carolina Medical Board (NCMB) launched the safe opioid prescribing initiative (SOPI) to limit overprescribing of opioids by investigating high volume prescribers and prescribers who have had two or more patient deaths due to opioid overdose. In this study we examined the immediate and sustained effects of NCMB’s SOPI on tapering and discontinuation of opioids among patients receiving high doses (>90 MME) of long-term (>90 days) opioid therapy (LTOT). Methods We conducted an interrupted time series study to examine change in temporal trends of opioid discontinuation and appropriate and inappropriate tapering among high dose LTOT patients in NC, following the NCMB’s implementation of SOPI in May 2016. We used de-identified data from January 2010 through March 2017 from the NC Controlled Substances Reporting System (CSRS). Results During the study period 205,255 people received high dose LTOT in NC. Compared to ∼0.01% monthly decline in discontinuation and tapering pre-SOPI, immediately after the implementation of SOPI, the rate of abrupt discontinuation, inappropriate tapering, and appropriate tapering of opioids among high dose LTOT patients increased by 1% (95% CI: -0.22, 2.23), 2.2% (95% CI: 0.91, 3.47) and 1.3% (95% CI: 0.96, 1.57), respectively. Those receiving opioids from one prescriber were more frequently discontinued, while multiple prescriber patients were more frequently inappropriately tapered post-SOPI. Conclusions The increase in appropriate tapering can be considered a success of SOPI, but, the simultaneous increase in discontinuations and inappropriate tapering may be cause for some concern as these results represent a chilling effect on opioid prescribing that may adversely affect those receiving high dose LTOT. Significance to Injury and Violence Prevention Science Well-intentioned policies such as the SOPI may have harmful effects when not well communicated and combined with education of prescribers to prevent potential unintended consequences.