University of Georgia researchers to study whether laws on painkillers impact patients

ATHENS — As states have reacted to the higher incidence of painkiller abuse with stricter laws, have those laws also adversely impacted patients who need those drugs? That’s a question researchers at the University of Georgia hope to answer with the help of a $150,000 grant.

Researchers in the UGA School of Public and International Affairs are using the grant from the Robert Wood Johnson Foundation to evaluate whether prescription drug monitoring programs in place in most states for medications such as Oxycontin and Vicodinare are keeping patients who need opioids from receiving them.

Health and law enforcement officials have noted the rise in prescription drug abuse, particularly strong painkillers. The Centers fior Disease Control and Prevention says that 46 people a day in the United States die from abusing those medicines.

Speaking to students at Lee County High School last October, Georgia Attorney General Sam Olens said that prescription drug abuse resulted in 700 deaths in Georgia in 2013.

“Parents know how much liquor they have in the liquor cabinet and when they go out they warn their kids they know exactly how much is in there,” Olens told the students. “But most parents don’t pay attention to the medicine cabinet and nowadays there are so many strong prescription drugs in the medicine that we frankly need to pay much, much more attention.

“The contents of a medicine cabinet can be far more addicting and lethal than anything else in the house. More people die each year from prescription drug abuse than car wrecks.”

In 2012, 259 million prescriptions were written for narcotic pain relievers, or about one prescription for every adult in the U.S. That year, half of the 10 of the most-prescribed states were in the South, with Alabama and Tennessee leading with 143 prescriptions per 100 residents, the CDC reported. Georgia was in the average group with 91 prescriptions per 100 residents, while patients least likely to get a narcotic pain killer were in Hawaii (52 prescriptions per 100 residents) and California (57).

In 2012, Tennessee began requiring that prescribers check the state’s prescription drug monitoring program before writing a script for a painkiller, resulting in a 36 percent reduction in the number of patients in that state who were seeing multiple prescribers to obtain a higher quantity of the same drug, the CDC reported.

The grant program, through the foundation’s Public Health Law Research program, is designed to provide funding for studies that analyze or evaluate laws and their effect on public health, UGA officials said.

“With prescription drug monitoring programs covering nearly every state, they have the potential to have a widespread effect on people’s access to important therapies for pain, yet no one has analyzed the relationship between the monitoring programs and pain management,” said Courtney Yarbrough, a second-year doctoral student in the department of public administration and policy. “The grant gives us the opportunity to explore the implications of these laws in detail and to provide objective information to policymakers and states as they continue to update their programs.”

Yarbrough and W. David Bradford, the George D. Busbee chair in Public Policy in the Department of Public Administration and Policy, are collaborators on the grant.

“Opioids fall under the Controlled Substances Act because of their potential to be addictive and can be very dangerous if taken inappropriately,” Bradford said. “Opioids have become a major public health concern in recent years. Between 1999 and 2010, sales of opioid analgesics increased by more than 300 percent, and opioid overdose deaths rose 265 percent for men and 415 percent for women.”

Most states have responded to the epidemic by implementing prescription drug monitoring programs, an electronic registry where doctors and pharmacists must report opioid prescriptions written and dispensed. The purpose of the programs is to monitor behavior and detect either inappropriate use by patients or inappropriate prescribing or dispensing by health care providers.

For many patients, opioids are the only feasible treatments for their pain. Prescription drug monitoring programs might have an adverse effect on pain management if they restrict access to drugs for people who need them by creating stigmas surrounding the drugs, discouraging doctors from prescribing them or making them more costly to obtain, according to Bradford.

Bradford and Yarbrough’s study will use data from the Medicare Current Beneficiary Survey, which tracks Medicare patients over time to examine changes in patients’ pain outcomes before and after prescription drug monitoring programs are implemented in their states. With this very rich data, the effects of the monitoring programs will be analyzed on a variety of patients—such as nursing home, hospice or cancer patients—who might be particularly vulnerable to changes in opioid access.

The study also will explore the differential effects of some state-to-state variations in monitoring programs.