Physician dispensing may have contributed to the unnecessary prescribing of strong opioids by some physicians in Florida, a recent study suggested.

The Workers’ Compensation Research Institute (WCRI), an independent, notforprofit research organization, analyzed 46,192 claims from injured workers to gauge the effect of Florida’s antipill
mill bill (HB 7095) on prescribing behavior. The ban, which went into effect on July 1, 2011, established standards of care for doctors who prescribe narcotics and restricted physician dispensing of strong opioids (prescriptions for these drugs can be filled at pharmacies).

Claims were separated into two groups: prereform, for injuries dating from Jan. 1, 2010 to June 30, 2010, and postreform, for injuries from July 1 2011 to Dec. 30, 2011. There were 24,567 prereform claims with 59,564 prescriptions and 21,625 postreform claims with 52,747 prescriptions included in this study.

The WCRI found a high rate of compliance with the ban by physician-dispensers. The number of workers receiving physician-dispensed strong opioids during the first six months for new injuries decreased from 3.9% to 0.5% after the ban. The WRCI also found an increase in physician-dispensed pain medications such as nonsteroidal antiinflammatory drugs (from 24.1% to 25.8%) and nonbanned opioids (from 9.1% to 10.1%). The researchers noted that only 2% of workers who received weaker physiciandispensed pain medication in the first six months required strong opioids in the next six months.

“When we compare preand postreform prescribing practices, it appears that physiciandispensers not only reduced their dispensing of strong opioids, but also reduced prescribing of strong opioids. This raises concerns that a significant proportion of prereform physiciandispensed strong opioids were not necessary, which means injured workers in Florida were put at greater risk for addiction, disability or work loss, and even death,” said Richard Victor, WCRI’s executive director, in a press release. “Since Florida has banned physician dispensing of strong opioids, the lessons of this study are relevant for the other states concerned about eliminating unnecessary costs in their system while protecting injured workers from unnecessary medical care.”

Lynn Webster, MD, past president of the American Academy of Pain Medicine, said dispensing from a physician’s office is typical of a problematic opioidprescribing business and that Florida in particular has had a problem with pill mills. He noted that there have been a lot of changes in Florida besides the pill mill ban that could have affected the amount of opioids prescribed.

“Increasingly physicians are reluctant to prescribe schedule II opioids due to fear of regulatory sanctions. Some pharmacies are not stocking schedule II like they had before the new laws so less is available,” said Dr. Webster. “So I would suggest caution in interpreting the reduction in prescribing as all due to the change laws.”

Dr. Webster advised to ensure that efforts to protect patients and the public do not abandon patients in pain. “At the same time public policymakers are working toward protecting patients, they should also ensure access and coverage for comprehensive pain programs that include behavioral and physical therapies along with medication management when necessary,” he said.

—PMN Staff

Based on a press release from the Worker’s Compensation Research Institute.

Original article:
Study suggests physician dispensing of opioids in Florida led to overprescribing. Pain Medicine News. February 5, 2015.