State-Mandated Prescribing Agreements for Patients with Chronic Non-malignant Pain in a Palliative Medicine Outpatient Clinic: Year Two (S754)

Abstract

•Understand the history of the mandate for prescribing agreements in patients with chronic non-malignant pain.•Identify the most common symptoms and diagnoses in patients who participated in mandated prescribing agreements.•Identify the violation rate for urine drug screens and possible risk factors for violating prescribing agreements. In response to an epidemic of deaths from opioid overdoses, Florida enacted laws that restricted prescribing of controlled pain medications for chronic non-malignant pain. Although hospice physicians were exempted from this mandate, physicians practicing palliative care in non-hospice settings were required to use prescribing agreements. We studied the impact of state-mandated prescribing agreements on patients with chronic non-malignant pain receiving care in an outpatient palliative medicine clinic. We studied all patients participating in mandated prescribing agreements from 2012 through 2013. We recorded patients' demographic information, pain-related diagnoses, duration of enrollment, and results of required urine drug profiles (UDPs). We examined relationships between these variables to identify risk factors for agreement violations. 28 patients participated in prescribing agreements during 2012, while 26 patients participated in 2013. The most common diagnosis was sickle cell disease, affecting 41% of patients. The most pain symptoms were back pain (39%) and arthralgia (32%). The rate for UDP violations was 18% in 2012 and 15% in 2013; the overall UDP violation rate for the study was 17%. Cannabinoids (89%) accounted for all but one UDP violation. Although males had 80% of UDP violations in 2012, only half of UDP violations involved males in 2013. During 2012, 8 patients had delays in submitting UDPs, and half experienced UDP violations, compared to just 2 of 20 patients who submitted UDPs on time. There were no delayed UDP results in 2013. The most common diagnoses were sickle cell disease and osteoarthritis. Most patients complied with their prescribing agreements, but 17% had UDP violations. Delay in submitting a UDP was a risk factor for violations, but 2013 results suggested male gender is not a risk factor.