THE EFFECT OF STATE LAWS DESIGNED TO PREVENT NON-MEDICAL PRESCRIPTIONOPIOID USE ON TREATMENT AND OVERDOSE DEATHS
Abstract
Background. The non-medical use of prescription drugs has reached epidemic levels in the United States. In 2013, according to National Survey on Drug Use and Health (NSDUH) about 70% of non-medical prescription drug users are opioid users with an estimated 4.5 million were nonmedical users of prescription opioids. Moreover, according to the Centers for Disease Control and Prevention (CDC), 16,235 deaths involved prescription opioids analgesic in the same year drug. Since 2009 deaths due to drug overdose are currently considered the leading cause of injury deaths in the United States exceed deaths due to 68 motor vehicle accidents. In addition, in 2007 prescription opioid abuse estimated to cost United States about $55.7 billion. Due to these high prevalence rates and social costs, federal, state, and local legislations and initiatives had been enacted in an effort to regulate and mitigate non-medical use of prescription opioids. Pain management clinic and doctor shopping laws are example of states laws that attempt to reduce the availability of prescription opioids to non-medical users. Pain management clinic laws require state oversight of clinics and/or regulate the ownership of operation of such clinics. Doctor shopping laws make it illegal for patients to withhold from practitioners that they have received either any controlled substance or prescription order from another practitioner, or the same controlled substance, or one of similar therapeutic use. These laws attempt to reduce the availability of prescription opioids to non-medical users by restricting healthcare providers’ ability to dispense these medications and patients’ ability to withhold information on medication seeking from multiple providers. Curtailing the supply of prescription opioids for non-medical use in this manner is potentially effective as healthcare providers represent the main source for prescription opioids for non-medical use. To date, there is little evidence on the effectiveness of these laws. Methods. A differences-in-differences design was used to study the impact of pain management clinic regulation and doctor shopping laws on opioid abuse treatment and opioid overdose death rates. The use of difference-in-differences design has become the gold standard in policy evaluation research. We study the effect of the laws on two measurable outcomes: opioid abuse treatment and opioid overdose death rates. We compare these outcomes between states that implemented the laws (treatment group) and states that have not implemented the laws (control group) (first difference). In addition, we compare the outcomes before and after law implementation (second difference). In other words, we take advantage of the differences among states in the timing of the law implementation which creates a natural experiment. Results. Pain management clinic regulation reduces the rates of prescription opioid overdose death by 23.2%. We find some evidence that pain management clinic regulation reduces the number of clients receiving opioid abuse treatment by 65.3%. Conclusions. Very little knowledge exists on the effectiveness of the laws under study. As policymakers are struggling to curb the prescription opioid abuse epidemic, they are searching for evidence that would help select the best state laws to address the epidemic. For example, pain management clinic regulation is more likely than doctor shopping laws to reduce opioid overdose death rates as well as the number of clients receiving opioid treatment.
THE EFFECT OF STATE LAWS DESIGNED TO PREVENT NON-MEDICAL PRESCRIPTIONOPIOID USE ON TREATMENT AND OVERDOSE DEATHS
POSTER PRESENTATIONS
Background. The non-medical use of prescription drugs has reached epidemic levels in the United States. In 2013, according to National Survey on Drug Use and Health (NSDUH) about 70% of non-medical prescription drug users are opioid users with an estimated 4.5 million were nonmedical users of prescription opioids. Moreover, according to the Centers for Disease Control and Prevention (CDC), 16,235 deaths involved prescription opioids analgesic in the same year drug. Since 2009 deaths due to drug overdose are currently considered the leading cause of injury deaths in the United States exceed deaths due to 68 motor vehicle accidents. In addition, in 2007 prescription opioid abuse estimated to cost United States about $55.7 billion. Due to these high prevalence rates and social costs, federal, state, and local legislations and initiatives had been enacted in an effort to regulate and mitigate non-medical use of prescription opioids. Pain management clinic and doctor shopping laws are example of states laws that attempt to reduce the availability of prescription opioids to non-medical users. Pain management clinic laws require state oversight of clinics and/or regulate the ownership of operation of such clinics. Doctor shopping laws make it illegal for patients to withhold from practitioners that they have received either any controlled substance or prescription order from another practitioner, or the same controlled substance, or one of similar therapeutic use. These laws attempt to reduce the availability of prescription opioids to non-medical users by restricting healthcare providers’ ability to dispense these medications and patients’ ability to withhold information on medication seeking from multiple providers. Curtailing the supply of prescription opioids for non-medical use in this manner is potentially effective as healthcare providers represent the main source for prescription opioids for non-medical use. To date, there is little evidence on the effectiveness of these laws. Methods. A differences-in-differences design was used to study the impact of pain management clinic regulation and doctor shopping laws on opioid abuse treatment and opioid overdose death rates. The use of difference-in-differences design has become the gold standard in policy evaluation research. We study the effect of the laws on two measurable outcomes: opioid abuse treatment and opioid overdose death rates. We compare these outcomes between states that implemented the laws (treatment group) and states that have not implemented the laws (control group) (first difference). In addition, we compare the outcomes before and after law implementation (second difference). In other words, we take advantage of the differences among states in the timing of the law implementation which creates a natural experiment. Results. Pain management clinic regulation reduces the rates of prescription opioid overdose death by 23.2%. We find some evidence that pain management clinic regulation reduces the number of clients receiving opioid abuse treatment by 65.3%. Conclusions. Very little knowledge exists on the effectiveness of the laws under study. As policymakers are struggling to curb the prescription opioid abuse epidemic, they are searching for evidence that would help select the best state laws to address the epidemic. For example, pain management clinic regulation is more likely than doctor shopping laws to reduce opioid overdose death rates as well as the number of clients receiving opioid treatment.