Florida Ban On Physician Dispensing Of Opioids Reduced Opioid Prescribing


Cambridge, MA (WorkersCompensation.com) - A new study from the Workers Compensation Research Institute (WCRI) finds the Florida law banning physician dispensing of stronger opioids reduced the use of opioids prescribed for injured workers.

The law banned physician dispensing of stronger opioids (except in very limited circumstances) but did not restrict physician prescribing of these medications. Rather, the stronger opioids could only be obtained from pharmacies.

The study, Impact of Banning Physician Dispensing of Opioids in Florida, found that the average Florida physician-dispenser continued to dispense pain medications after the ban, but increased the use of less addictive pain medications like ibuprofen and Tramadol. The physician-dispensers could have continued to prescribe the stronger opioids (e.g., hydrocodone-acetaminophen), but would have been required to send the patients to pharmacies. The study reports no material change in the percent of patients who received stronger opioids from pharmacies.

The ban on physician dispensing of stronger opioids, House Bill 7095, went into effect July 1, 2011. The study examined the medical care received by injured workers with injuries occurring prior to the law change and after the law change. Patients' prescription histories were analyzed for the first 3–6 months after the injury.

The study found a high rate of physician compliance with the ban. After the law change, only 0.5% of injured workers received physician-dispensed stronger opioids, and most of these fit within the limited exceptions provided by the law.

The study also found that the overall use of stronger opioids dropped after the law change. Looking at evidence from 3-6 months of treatment after the work injury, percent of workers receiving stronger opioids was 14.5 before the ban. This fell after the law change to 12.4 percent.

The researchers would have expected little change in the percentage of patients getting stronger opioids—only a change from physician dispensed to pharmacy dispensed. Instead of finding an increase in pharmacy-dispensed stronger opioids, the study found no material change. Rather, there was an increase in the percentage of patients receiving physician-dispensed nonsteroidal anti-inflammatory medications (e.g., ibuprofen)—from 23.8 percent of patients to 26.0 percent. There was a smaller increase in the use of weaker opioids—from 9.0 to 9.8 percent of patients.

According to the study, the policy debate in a growing number of states has been focused on the much higher prices charged by physician-dispensers than pharmacies for the same medication. The debate has not focused on whether the economic incentives attendant to physician dispensing (like any form of physician self-referral) lead to prescribing and dispensing of unnecessary medications.

“This study provides tentative evidence that is consistent with patients of physician-dispensers receiving more opioids than necessary. If this evidence is correct, it could shift the policy debate from whether or not there are substantial benefits to some patients from physician dispensing, to whether or not there are substantial harms to some patients from physician dispensing,” said Richard Victor, WCRI's executive director.

He cautioned that the results from this study are not definitive and could also be consistent with several other possible explanations. WCRI is planning an additional study that examines patients at a greater length of time from injury to provide more definitive information.

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