Prescription Monitoring Program and “Pill Mill” Laws Have Had Modest Effects on Opioid Overprescribing in Florida

In the mid-2000s, Florida had high rates of prescription opioid overdoses and physicians who were dispensing or prescribing large quantities of opioids (“pill mills”). In response to this, the state enacted laws in 2010 to discourage these practices and established a prescription monitoring program (PMP) that became operational in 2011. This study used data from a cohort of 2.6 million individuals who filled 480 million prescriptions in Florida and Georgia (as a comparison), July 2010–September 2012, and investigated changes in opioid prescribing practices.

• During the pre-implementation period, the total volume of opioids (in mean morphine equivalents [MME]), mean MME per transaction, and mean days’ supply per transaction were higher in Florida than in Georgia.
• When comparing the pre- and post-implementation periods in Florida, the total opioid volume in MME declined 4%, the mean MME per transaction declined 5.7%, while the mean days’ supply per transaction increased 3.8% and there was no change in the number of opioid prescriptions. The greatest differences were among prescribers with the highest baseline opioid prescribing rates. Georgia also had declines in opioid volume and mean MME, but less than those observed in Florida.
• It was estimated that the change resulted in a reduction in prescribing equivalent to 500,000 5 mg hydrocodone tablets per month in Florida.

Comments:

The measures implemented in Florida are reasonable but only modestly effective, probably because they only affect the outliers. Most of the prescription opioids that are fueling the current epidemic are not coming from “pill mills.” Individuals who divert prescription opioids generally receive them from a single prescriber and this would not be influenced by the implementation of a PMP, which targets “doctor shopping” (seeking overlapping prescriptions from multiple providers).

Darius A. Rastegar, MD

Reference:

Rutkow L, Chang HY, Daubresse M, et al. Effect of Florida’s prescription drug monitoring program and pill mill laws on opioid prescribing and use. JAMA Intern Med. 2015;175(10):1642–1649.