PDG15 Trends in Utilization of Amphetamine-Containing Medications Following State Level Restriction Laws for Acute Pain Opioid Prescriptions

Abstract

In 2018, several states enacted laws restricting opioid prescriptions for acute pain: Florida (FL) and Tennessee (TN) limited opioid prescriptions for acute pain to a 3-day supply, Colorado (CO) and South Carolina (SC) to a 7-day supply, and Mississippi (MS) to a 10-day supply. These restrictions have been associated with some decreases in opioid prescribing, but their effect on utilization of amphetamine-containing medications is unknown. Given the increased concern of rising stimulant-related overdoses in the United States, we aimed to assess changes in utilization of prescription amphetamines before and after implementation of the state’s restriction on opioids. We evaluated the prevalence of use of amphetamine-containing medications using aggregated prescription data from the Medicaid State Drug Utilization Database from 3/2016 to 3/2020 for FL, TN, CO, SC, and MS. As an estimate of enrollment for the fiscal quarter, we extracted the number of total Medicaid and CHIP enrollees reported by the Centers for Medicare and Medicaid. We analyzed the effects of the law (step and trend changes) by fitting interrupted time series models on the rate of amphetamine-containing prescriptions among total enrollees for each study quarter. There were no significant changes in use of amphetamine-containing medications in CO, MS, and TN after policy changes. In FL, there was an increase in utilization of amphetamine-containing medications after the law was implemented: significant step change (6.3 per 1,000 enrollees, p=0.005) and a significant trend change (1.2 per 1,000 enrollees per month, p=0.005). SC showed a significant decrease in the trend after the policy (2.1 per 1,000 enrollees per month, p=0.013). The FL law, one the strictest opioid prescribing laws in the country, was associated with an increase of amphetamine-containing medication use among Medicaid enrollees. Further research is needed to evaluate the effect of opioid policies at the national level.