Physician Dispensing May Have Led to Unnecessary Prescribing of Opioids, Study Says
According to a new study from the Workers Compensation Research Institute (WCRI), physician dispensing — when a doctor gives medication to a patient directly — may have led to doctors overprescribing strong opioids. The authors of the study, The Impact of Physician Dispensing on Opioid Use, found that after Florida banned physician dispensing of strong opioids, more patients were prescribed alternative painkillers such as ibuprofen and instead of patients visiting a pharmacy for strong opioids, they simply took the weaker medication given to them by their doctor.
After the ban, the percentage of patients receiving physician-dispensed weaker pain medication increased from 24.1 percent to 25.8 percent. The percentage receiving weaker, but not banned opioids increased from 9.1 percent to 10.1 percent.
The study found that most doctors complied with the ban. Before the reforms, 3.9 percent of injured workers received strong opioids dispensed by physicians during the first six months after their injuries. After the ban, only 0.5 percent of patients with new injuries received physician-dispensed strong opioids.
If the pre-ban strong opioids were necessary, researchers figured that workers who received weaker physician-dispensed pain medications after the ban would eventually need to visit a pharmacy to receive strong opioids. But only 2 percent of those with weaker physician-dispensed pain medications in the first six months after the ban received strong opioids at a pharmacy in the next six months.
“When we compare pre- and post-reform prescribing practices, it appears that physician-dispensers not only reduced their dispensing of strong opioids, but also reduced prescribing of strong opioids. This raises concerns that a significant proportion of pre-reform physician-dispensed strong opioids were not necessary, which means injured workers in Florida were put at greater risk for addiction, disability or work loss, and even death,” said Richard Victor, WCRI’s executive director. “Since Florida has banned physician dispensing of strong opioids, the lessons of this study are relevant for the other states concerned about eliminating unnecessary costs in their system while protecting injured workers from unnecessary medical care.”
This study analyzed data on the medications dispensed for injured workers covered by the Florida workers’ compensation program. It included both open and closed Florida claims. The claims were divided into two groups: pre-reform, with dates of injury from January 1, 2010, to June 30, 2010 (prior to the July 1, 2011, effective date of the ban) and post-reform, with dates of injury from July 1, 2011, to December 30, 2011 (immediately after the ban). The data included 24,567 claims with 59,564 prescriptions in the pre-reform group and 21,625 claims with 52,747 prescriptions in the post-reform group.