Health Policy and Health Services Research
Abstracts
Sunday Clark, ScD, MPH
New York–Presbyterian Hospital/Weill Cornell Medical Center
Background: Opioid addiction is a serious health crisis with staggering economic and social consequences. On July 1, 2018, the Florida legislature implemented new legislation for healthcare practitioners who prescribe controlled substances. The law restricts the number of days an acute pain prescription can cover and requires consultation of a statewide database before prescribing or dispensing controlled substances. This study evaluated the impact of this legislation on prescribing practices at emergency departments (EDs) of a large health care system. Methods: This cross-sectional quasi-experimental study was conducted at one of Central Florida’s largest health care systems including two tertiary care trauma centers. Discharge and prescription information from the system’s ED visits were captured in an administrative database. Data were extracted pre and post implementation of the new legislation from two similar time periods; July 1, 2017 to October 31, 2017 (pre) and July 1, 2018 to October 31, 2018 (post). The main outcomes were changes in frequency of controlled substance prescriptions among ED practitioners, changes in controlled substance schedules (categories II through V), and changes among different practitioners. Results: There were 184,613 patient ED encounters included in the analysis, 90,367 prior to the law’s implementation and 94,246 afterward. Overall mean age of patients was 36 (SD19) years and 61% were female, There was a significant decrease in the proportion of controlled substance prescriptions from 16,503 (18.3%) pre-legislation to 11,391 (12.1%) post-legislation (p<0.001). Schedule II prescriptions decreased from 11.9% to 7.7%, Schedule III from 0.2% to 0.1%, Schedule IV from 5.8% to 4.1% and Schedule V from 0.3% to 0.2%. Prescriptions by ED physicians decreased from 13,948 (36.3%) to 9,418 (25.8%) (p<0.001), by residents/fellows from 1,327 (11.7%) to 1,027 (7.2%) (p<0.001), and advanced practice providers from 1,228 (3.0%) to 946 (2.2%) (p<0.001). Conclusions: Following implementation of this new legislation there were significant decreases in the frequency of controlled substance prescriptions from the ED. The decreases were significant across all ED providers and across all controlled substance schedule categories. The short term impact appears significant but long term impacts have yet to be measured.