Texas “Pill Mill” Law Reduces Opioid Dose and Volume

The impact of “pill mills,” which prescribe opioids but provide inadequate clinical management, on opioid supply at the population-level is largely unknown. This study examined the effect of the 2010 Texas “pill mill” law. Using prescription claims data that included 65% of retail prescription transactions nationally, investigators created a cohort of 8.3 million patients with prescription claims during a 24-month period. Patient and provider-level outcomes were compared over 12 months pre-intervention (September 2009–August 2010) and post-intervention (September 2010–August 2011).

• 12 months after the policy change, average morphine equivalent dose (MED) per transaction was 48.2 mg in a month; 8.1% lower than the expected 52.5 mg.
• Opioid volume declined by 9.99 kg in a month. Opioid volume, total number of opioid prescriptions, and quantity of opioid pills dispensed were 24%, 23%, and 20% lower, respectively, than expected at one year.
• Prescribers with highest quartile opioid volume prescribing at baseline had the greatest change compared with prescribers with lower prescribing volumes; among prescribers in the lowest prescribing quartile there was no decrease in prescribing.
• Investigators estimated the decrease in opioids in circulation at one year could have supplied every person aged 45–49 in Texas for a week of around-the-clock hydrocodone/acetaminophen (Vicodin).

Comments:

The study was limited by absence of a control group to compare changes in states without policy change; secular changes in opioid-prescribing patterns could explain observed differences. Nonetheless, policy approaches that decrease the supply of opioids at the population level are critical to support clinical-level interventions to reduce unnecessary exposure to opioids and reduce morbidity and mortality.

Hillary Kunins, MD, MPH, MS

Reference:

Lyapustina T, Rutkow L, Chang HY, et al. Effect of a “pill mill” law on opioid prescribing and utilization: the case of Texas. Drug Alcohol Depend. 2016;159:190–197.