161. Effects of Drug Enforcement Agency (DEA) narcotic restrictions on a multidisciplinary spine practice: analysis of patient discharges from the practice during a 10-year period

Abstract

BACKGROUND CONTEXT In the late 1990s to early 2000s, concern about pain under-treatment resulted in greater numbers of prescriptions for pain medications being written across the United States. After this, according to CDC data, from 1999 to 2017, more than 700,000 people died from a drug overdose with approximately 68% of the more than 70,200 opioid-related overdose deaths in 2017 alone. Government agencies across the country have taken measures to address this alarming trend. An instrumental change occurred on October 6, 2014 when the US Drug Enforcement Agency (DEA) rescheduled hydrocodone combination products from Schedule III to Schedule II to make obtaining narcotics more difficult. PURPOSE The purpose of this review was to investigate the effects of DEA policy changes on patient discharges in a multidisciplinary spine practice. STUDY DESIGN/SETTING This study involved a review of patient discharges from a spine specialty clinic due to violations of the medication contract between patients and the clinic. PATIENT SAMPLE The study was based on all patients who were seen at a multisite spine specialty clinic between 2008 and 2018, with no changes in discharge policy during this time. There were a total of 636 patients discharged from the practice during this time. OUTCOME MEASURES The primary outcome measure was the occurrence of patient discharge from the practice. The specific reason for each discharge related to violating the medication contract and/or for noncompliance was recorded. METHODS All patients were required to sign a medication contract noting that abuse of medication subscription policy would result in discharge of the patient from the practice. Patients also agreed to random drug screening to determine compliance with prescribed medication. All patient discharges are reviewed and recorded by the medical administrator of the practice. The number and reasons for discharges were compiled into a monthly summary. Reasons for discharges were recorded as obtaining medication from another provider, diversion, self-medicating/early refills/drug overdose, refusal or alteration of urinalysis sample, altering a prescription, rude/abusive behavior, and noncompliance/failed to show for appointments. The years 2008 through 2013 were combined as the experience prior to the DEA change and 2015 through 2018 were combined as the post-DEA change years. The year 2014 was not included since the change in DEA policy was implemented during that year. The number of discharges occurring during each of the two periods was divided by the number of individual patients seen (counted by individual patients, not patient visits) during the same periods to derive a discharge rate for each reason. RESULTS Before and after the DEA changes, the most frequent reason for medication violation discharge from the practice was obtaining medication from other practitioners. However, the discharge rate for this violation decreased significantly after the DEA change was implemented (0.29% vs 0.02%; p CONCLUSIONS This analysis found that rescheduling of Hydrocodone from Class III to Class II by the DEA was associated with reduced patient discharge rates from a spine specialty practice. Significant decreases in discharges were found for medication-related policy violations, especially obtaining medication from other providers. While these reductions are a positive impact of the DEA policy change, one item that could not be addressed in the current analysis was the potential for increased difficulty for patients legitimately trying to fill prescriptions, for example, postoperative pain management following complex reconstructive spine procedures. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.