Doctor of Philosophy
David A Holdford
Introduction: Prescription drug monitoring programs (PDMPs) are one strategy established to curb the prescription opioid abuse epidemic. Prescriber use mandates has emerged as a promising practice to increase PDMPs impact on prescription opioid abuse; however, evidence of its effectiveness has not yet been established. Kentucky was the first state to implement comprehensive prescriber use mandates in July 2012.
Objective: To assess the relationship between prescriber use mandates policy and emergency department (ED) visits related to prescription opioid poisoning among adults in Kentucky and
North Carolina. Secondary aim: to evaluate the economic impact of prescriber use mandates in Kentucky.
Methods: A controlled, pre-post study design. Data from the State Emergency Department Databases (SEDD) and the State Inpatient databases (SID) were used to identify prescription opioid poisoning ED visits among those ≥ 12 years old. Prevalence rate were estimated. Prescription opioid poisoning ED visits were characterized based on sociodemographic and clinical characteristics. Logistic regression was applied to compare occurrences of prescription opioid poisoning ED visits pre and post prescriber use mandates in Kentucky, and between Kentucky and North Carolina for the period 2011 to 2014. A cost of illness framework was applied to estimate direct medical costs associated with prescription opioid poisoning ED visits. The economic impact of prescriber use mandates was quantified based on logistic regression coefficient for the interaction term (state*time to implementation).
Results: There were 7,419 and 12,598 prescription opioid poisoning -related ED visits in Kentucky and North Carolina, respectively. Young and Middle age, male gender, white, having one or more chronic conditions, and psychiatric conditions (such as depression and drug abuse) were significantly associated with prescription opioid poisoning ED visits (p-value<0.05). The odds of having a prescription opioid poisoning ED visit in Kentucky were significantly lower compared to North Carolina in 2012, 2013, and 2014 compared to 2011 (OR = 0.9, 0.7, and 0.7 respectively). The total estimated direct medical costs were $13.77 and $24.37 million in Kentucky and North Carolina, respectively. In Kentucky, the economic impact of prescriber use mandates was estimated at - $2.3 million.
Conclusion: Prescriber use mandates is effective in reducing prescription opioid poisoning ED visits, and its economic impact is considerable.
© Almanie A. Sarah
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