Assessing the impact of the extended-release/long-acting opioid analgesics risk evaluation and mitigation strategies on opioid prescription volume

Victoria Divino, BA; M. Soledad Cepeda, MD, PhD; Paul Coplan, ScD, MBA, MPH; Jean-Yves Maziere, MD, PhD; Yingli Yuan, PhD; Rolin L. Wade, RPh, MS

doi:10.5055/jom.2017.0383

Authors

Victoria Divino, BA
M. Soledad Cepeda, MD, PhD
Paul Coplan, ScD, MBA, MPH
Jean-Yves Maziere, MD, PhD
Yingli Yuan, PhD
Rolin L. Wade, RPh, MS

DOI:

https://doi.org/10.5055/jom.2017.0383

Keywords:

opioids, risk evaluation mitigation strategies, utilization, physician specialties, prescribing patterns

Abstract

Objective: The Food and Drug Administration approved the extended-release/long-acting (ER/LA) opioid analgesics risk evaluation and mitigation strategies (REMS) in July 2012 to educate healthcare providers and patients about safe and appropriate opioid analgesic use. The authors evaluated the impact of the REMS on ER/LA opioid analgesic utilization, overall and stratified by patient characteristics and prescriber type associated with greater expected need for analgesia. Design: Retrospective repeated cross-sectional study. QuintilesIMS's National Prescription Audit™ and LifeLink™ patient-level longitudinal prescription databases measured prescription volumes, projected to national estimates.

Main Outcome Measures: Changes were assessed in ER/LA opioid analgesic prescriptions dispensed from the 2-year pre-REMS implementation (July 2010 to June 2012) to the 18-month post-REMS implementation (July 2013 to December 2014) periods (with 12-month transitional implementation period in between).

Results: Average quarterly ER/LA opioid prescription volume significantly decreased by 4.3 percent from Preimplementation to the Active Period (5.58 vs 5.34 million, p < 0.001). Differences in prescription volume change were observed between age, gender, and payer types. Prescription volume either significantly decreased or remained stable from Preimplementation to the Active Period among most provider specialties evaluated. The largest volume decreases were observed for dentists (–48.5 percent) and emergency medicine specialists (–25.5 percent) (both p < 0.001). The largest increases were observed for nurse practitioners (+33.7 percent) and physician assistants (+31.2 percent; both p < 0.001), whose overall prescribing of nonopioid medications also increased.

Conclusions: A significant decrease in dispensed ER/LA opioid prescriptions was observed following REMS implementation compared to Preimplementation. The impact on volume varied by patient characteristics and prescriber specialty. The REMS program, in conjunction with other healthcare policies and initiatives, likely influenced these observations.

Author Biographies

Victoria Divino, BA

Health Economics and Outcomes Research, Real World Evidence Solutions, QuintilesIMS, Fairfax, Virginia

M. Soledad Cepeda, MD, PhD

Department of Epidemiology, Janssen Research and Development, Titusville, New Jersey

Paul Coplan, ScD, MBA, MPH

Medical Affairs, Purdue Pharma L.P., Stamford, Connecticut

Jean-Yves Maziere, MD, PhD

formerly in an RPC Member Company and was a member of the RPC Metrics Subteam

Yingli Yuan, PhD

Health Economics and Outcomes Research, Real World Evidence Solutions, QuintilesIMS, Fairfax, Virginia

Rolin L. Wade, RPh, MS

Health Economics and Outcomes Research, Real World Evidence Solutions, QuintilesIMS, Fairfax, Virginia

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