[N]ew data from Vermont’s largest hospital underscores a continuing trend: doctors are sending patients home with fewer opioid pills in an effort to combat addiction.
It’s not yet clear, however, what impact that that dramatic change in prescribing practices is having on public health.
Now, researchers in Vermont and Maine are taking a closer look at opioid-prescription trends and the state rules that are helping drive those numbers. The study – funded by a federal grant to the Northern New England Clinical and Translational Research Network – will address key questions like whether prescription regulations are leading to fewer overdoses.
The answers could have nationwide implications for efforts to combat the opioid epidemic.
“This is a huge issue,” said Valerie Harder, the project’s lead investigator and an associate professor at University of Vermont’s Larner College of Medicine. “It’s a crisis in our whole country. It’s not just Vermont or Northern New England.”
Vermont officials have for years been working to stem the flow of prescription opiates. That culminated last year in the implementation of new state rules that set limits on opioid prescriptions based on a patient’s age and pain levels.
The rules also call for more patient education, consideration of non-opioid treatment and periodic re-evaluation of dosage.
Those rules – along with the efforts of state officials and health care administrators before and after the new regulations took effect – have led to a significant reduction in the number of prescription painkillers distributed in Vermont.
State data shows that the total morphine milligram equivalents – a measurement of an opioid’s potency – dispensed in Vermont dropped from 110.1 million in the first quarter of 2016 to less than 79 million in the first quarter of this year.
Blue Cross and Blue Shield of Vermont, the state’s largest insurer, says opioid claims for its members peaked in 2012-13. Those prescriptions began to decline as state officials prioritized the issue, and the insurer saw a big drop when Vermont’s new prescribing rules took effect in July 2017.
Blue Cross has said its members “will receive about 672,000 fewer opioid pills per year as a result of the new Vermont prescribing guidelines.”
On Thursday, University of Vermont Medical Center administrators said they had documented a 44 percent decline in the number of opioid prescriptions for more than 50 pills when comparing the third quarter of the hospital’s fiscal year 2018 to the same time period last year.
Since 2016, those types of prescriptions are down 71 percent at UVM Medical Center. The biggest reduction happened in the first part of 2017 because “we’d already made a massive change in our prescribing” before the new state rules took effect, said Dr. Stephen Leffler, the hospital’s chief population health and quality officer.
But the question is whether reduced prescriptions equal improved health. Some experts have raised concerns that prescription limits could have unintended consequences, causing patients with legitimate need to become “pain refugees” who’ve been abruptly cut off from their medications.
Unintended consequences are one area of inquiry for the new Maine-Vermont study, which was awarded a $339,000 grant from the National Institutes of Health. Harder will be joined by Dr. Timothy Plante of UVM and Dr. Kathleen Fairfield from Maine, where officials have enacted opioid-prescribing rules similar to Vermont’s.
Researchers will examine health data from both states as well as electronic medical record information from UVM Medical Center and Maine Medical Center in an effort to better understand the effects of shifting prescription regulations.
“The policy change has happened, and we’d like to look at the impacts of this change on health outcomes – specifically, opioid overdose and opioid-related medical events,” Harder said.
“It really takes a critical eye to kind of dig down into the data,” she added.
Key issues include the impact of of prescribing policies on various demographic groups with various experiences – for instance, those with other medical conditions or other prescription use.
Researchers also want to know whether overdoses are declining due to governmental policy changes. In Vermont, statistics show no immediate decline in 2017. The state reported a 5 percent increase in opioid-related fatalities last year, and officials said the number of deaths involving a prescription opioid had “remained relatively consistent since 2015.”
The Maine-Vermont study could provide fodder for policy revisions, depending on the findings.
“The first step is really evaluating the impact of the already conducted policy change – looking at the health outcomes,” Harder said. “And then thinking about, how do we inform future policy.”
Harder said researchers aren’t going it alone: they are seeking input from “community groups and stakeholders … to help us really refine and develop our questions and how we want to look at the data we have.”
At this point, the study is funded for one year, though researchers could seek additional resources to expand the project or pursue additional questions.
“I think it could grow from here,” Harder said. “I’m hopeful of what we can accomplish in one year, but it’s a short time period.”
