Hello AHSR,
Sorry for the delayed submission! I thought the deadline was this Friday. Please see the attached for the poster.
Abstract:
Objectives: For patients with sickle cell disease (SCD) and patients with cancer with bone metastasis (CBM), medical crises that result in emergency department (ED) encounters are often extremely painful and opioid therapies remain first-line pain management strategies. Policies aimed at improving the safety of opioid prescribing in the general population may have inadvertently restricted opioid prescribing to these two populations. This study assessed the association between Prescription Drug Monitoring Program (PDMP) “must-access” laws and opioid dispensing following an emergency department (ED) encounter for these two populations. Methods: Study data came from the 2011-17 Health Care Cost Institute commercial insurance database. Privately insured patients with an active diagnosis of SCD or CBM, aged 18-64, had at least one ED encounter, and resided in the 29 states with online access to PDMP by 2011 were included. We categorized PDMP “must-access” laws into no mandate, non-comprehensive mandate, comprehensive mandate to account for the heterogeneity of policies between states. Difference-in-Differences models, separately for the two populations, were employed to assess policy effects on the probability of filling an opioid prescription after an ED visit, and Morphine Milligram Equivalents (MMEs) of the prescription. Results: Comprehensive PDMP mandate was associated with a 4.3-percentage-point decrease (p=0.043; 27% relative reduction) among SCD patients and a 3.5-percentage-point decrease (p=0.005; 24% relative reduction) in the probability of opioid dispensing after an ED encounter among CBM patients. In addition, comprehensive mandates were associated with a 47% (p=0.003) reduction in MMEs of opioids dispensed to SCD patients. Non-comprehensive mandates were not associated with significant changes in either outcome. Conclusions: Comprehensive use mandates for PDMPs were associated with a substantial reduction in the rate of opioid prescribing in the ED to both populations and a substantial reduction in the amount of opioids received by patients with SCD.
