1 Kaiser Permanente Colorado, Aurora; Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora; and Regis University School of Pharmacy Rueckert-Hartman College for Health Professions, Denver, Colorado.
2 Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora.
J Manag Care Spec Pharm. 2017 Mar;23(3):346-354. doi: 10.18553/jmcp.2017.23.3.346.
The United States is currently experiencing an opioid abuse epidemic. Many policies and programs have been implemented at local, state, and national levels in an attempt to decrease prescription opioid addiction and overdose. On August 1, 2014, Colorado Medicaid implemented a policy change that limited the quantity of short-acting opioids (SAOs) that could be filled through the Medicaid benefit to no more than 4 tablets per day, or 120 tablets in 30 days.
To compare mean total daily dose (TDD) of opioids purchased by Kaiser Permanente Colorado (KPCO) Medicaid patients before and after implementation of the Medicaid SAO quantity limit.
This investigation used a pre/post study design to compare opioid use in Medicaid-eligible patients during the 90 days before implementation of the Medicaid quantity limit on August 1, 2014, and 90 days after full implementation of the change on December 31, 2014. The study was conducted at KPCO, an integrated care delivery system providing medical care for approximately 615,000 patients, of which over 54,000 are Medicaid members. Electronic medical and pharmacy records were used to identify patients and assess medication use.
There was a small difference in opioid use in the population of Medicaid opioid users as evidenced by the median TDD of oral morphine equivalents (OME) purchased decreasing from 6.8 mg (IQR = 2.2-25.8) in the pre-implementation period to 6.6 mg (IQR = 1.7-24.0) in the postimplementation period (P = 0.027). The proportion of patients purchasing more than 120 mg OME per day and the proportion of patients purchasing long-acting opioids (LAOs) did not change significantly from the pre- to postimplementation period (OME > 120 of 4.2% vs. 3.6%, respectively, P = 0.290; LAO use of 12.9% vs. 13.6%, respectively, P = 0.465).
This study found a statistically significant 3% decrease of 0.2 mg OME per day in the primary study population. A 24% reduction of 10 mg OME per day before and after implementation of the Medicaid SAO quantity limit was found in those patients identified as exceeding the Medicaid SAO quantity limit at baseline. These patients tended to be purchasing low to moderate total daily doses of opioids at baseline.
Internal funding was provided by the Department of Pharmacy at Kaiser Permanente Colorado. There are no external funding sources to disclose. Riggs, Milchak, Patel, and Heilmann are employed by Kaiser Permanente Colorado. The authors report no other potential conflicts of interest. Study concept and design were contributed by Riggs, Heilmann, and Billups, along with the other authors. Billups collected the data, and data interpretation was performed by Riggs, Milchak, and Flores, with assistance from the other authors. The manuscript was written primarily by Riggs, along with Flores, and revised by Billups, Milchak, Patel, and Heilmann.
美国目前正经历阿片类药物滥用的流行。为了减少处方类阿片成瘾和过量用药，美国各地各级政府都实施了许多政策和项目。2014 年 8 月 1 日，科罗拉多州医疗补助计划（Medicaid）实施了一项政策变更，将通过医疗补助福利开出的短效阿片类药物（SAO）的数量限制在每天不超过 4 片，或 30 天内不超过 120 片。
比较 Kaiser Permanente Colorado（KPCO）医疗补助计划的患者在实施医疗补助 SAO 数量限制前后的平均每日总剂量（TDD）。
本研究采用前后研究设计，比较 2014 年 8 月 1 日实施医疗补助数量限制前 90 天和 2014 年 12 月 31 日完全实施变更后 90 天期间符合医疗补助条件的患者的阿片类药物使用情况。研究在 KPCO 进行，这是一个提供医疗服务的综合医疗服务系统，为大约 615000 名患者提供医疗服务，其中超过 54000 名是医疗补助计划的成员。电子医疗和药房记录用于识别患者并评估药物使用情况。
医疗补助计划阿片类药物使用者人群的阿片类药物使用情况略有差异，表现在口服吗啡当量（OME）的中位数 TDD 从实施前的 6.8 毫克（IQR=2.2-25.8）降至实施后的 6.6 毫克（IQR=1.7-24.0）（P=0.027）。购买每天超过 120 毫克 OME 的患者比例和购买长效阿片类药物（LAO）的患者比例在实施前后均无显著变化（OME>120 分别为 4.2%和 3.6%，P=0.290；LAO 使用率分别为 12.9%和 13.6%，P=0.465）。
本研究发现主要研究人群的 OME 日剂量减少了 3%，统计学上有显著意义，每天减少 0.2 毫克。在基线时超过医疗补助 SAO 数量限制的患者中，实施医疗补助 SAO 数量限制前后，每天减少 10 毫克 OME。这些患者在基线时往往购买低至中等剂量的阿片类药物。
科罗拉多州 Kaiser Permanente 的药房部门提供内部资金。没有外部资金来源需要披露。Riggs、Milchak、Patel 和 Heilmann 受雇于 Kaiser Permanente Colorado。作者报告没有其他潜在的利益冲突。Riggs、Heilmann 和 Billups 提出了研究概念和设计，其他作者也参与其中。Billups 收集了数据，Riggs、Milchak 和 Flores 进行了数据解释，并得到了其他作者的帮助。该手稿主要由 Riggs 与 Flores 撰写，并由 Billups、Milchak、Patel 和 Heilmann 修订。
