Anticipating the Effectiveness of Virginia’s Opioid Prescribing Rules

Last month, the Virginia Board of Medicine issued emergency regulations limiting the amounts of opioids providers can prescribe to patients. That action is one facet of the Commonwealth’s ongoing response to the opioid crisis that has resulted in an escalation of related deaths. The emergency regulations are in effect until March 2018, at which time they will be replaced with permanent regulations. The goal of the regulations is to decrease the number of patients who abuse or develop an addiction to opioids, and to serve as a barrier to over prescribing by practitioners. A key feature of the new regulations is a limit on the number of days for which opioids can be prescribed. For acute pain, the limit is seven days. To assess the regulation’s potential to limit or reduce exposure to opioids, the VHHA Analytics Team evaluated available 2015 opioid prescription data in the All-Payer Claims Database (APCD). As shown in the first chart below, more than 500,000 Virginians received opioid prescriptions, with more than 2.2 million prescriptions written. The second chart shows that more than three-fourths (79 percent) of patients received opioid prescriptions for seven days or less. That suggests the new regulation may not affect the majority of prescriptions. The spike reflecting prescriptions written for 30 days (or longer) could represent patients with chronic pain who are under the care of a pain specialist. Given the relatively elevated number of 30-day prescriptions, further analysis was conducted to determine whether there are frequent prescription opioid users among that group. The analysis shows a roughly evenly split – about half of those in that group received just one prescription, while the other half received more than one prescription within the year. So will Virginia’s new regulations influence opioid prescribing? Given the patterns in prescribing opioids in 2015, the ability of the new regulations to help reduce exposure and limit over prescribing could be limited. As of now, just 20 percent of patients receive prescriptions lasting longer than seven days. Of those receiving prescriptions for seven days or fewer, the data suggests 50 percent of them will receive a second prescription in the same year. Going forward, the regulations offer a baseline for further study of patient exposure to opioids. (4/21)


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