Shen Yun, Hincapie-Castillo Juan M, Vouri Scott M, Dewar Marvin A, Sumfest Jill M, Goodin Amie J
Department of Pharmaceutical Outcomes & Policy.
Center for Drug Evaluation and Safety.
Med Care. 2022 Jun 1;60(6):432-436. doi: 10.1097/MLR.0000000000001719. Epub 2022 Mar 22.
Florida House Bill 21 (HB21) was implemented in July 2018 to limit prescriptions of Schedule II opioids for acute pain patients, but it is unclear whether such restrictions have a collateral influence on the utilization of commonly prescribed adjuvant pain medications.
The objective of this study was to assess whether this law was associated with a change in use patterns of gabapentinoids, benzodiazepines, and muscle relaxants.
We obtained prescription claims for medications dispensed from January 1, 2015, to June 31, 2019, from a health plan serving a large Florida employer. Interrupted time series analyses were conducted to compare pre-HB21 and post-HB21 implementation changes in the mean monthly number of users and prescriptions for gabapentinoids, benzodiazepines, and muscle relaxants.
There was a 6% immediate increase (relative risk: 1.06; 95% confidence interval: 1.02, 1.11) in the monthly proportion of gabapentinoid users, and an 11% immediate increase in the monthly proportion of gabapentinoids prescriptions (relative risk: 1.11; 95% confidence interval: 1.04, 1.18) per 1000 patients following law implementation. However, after the law, we observed a significant reduction in trend for the monthly proportion of muscle relaxants and benzodiazepine users.
An increased number of patients and prescriptions were observed for gabapentinoids, while fewer patients received benzodiazepines and muscle relaxants after HB21. In previous studies, opioid prescription restriction laws are shown to reduce opioids, but this work suggests that these laws may also have unintended consequences for the use of adjunctive medications that were not intended to be affected.
佛罗里达州众议院法案21（HB21）于2018年7月实施，旨在限制为急性疼痛患者开具的II类阿片类药物处方，但尚不清楚此类限制是否会对常用辅助性疼痛药物的使用产生间接影响。
本研究的目的是评估该法律是否与加巴喷丁类药物、苯二氮䓬类药物和肌肉松弛剂的使用模式变化有关。
我们从为佛罗里达州一家大型雇主服务的健康计划中获取了2015年1月1日至2019年6月31日期间发放的药物处方申请。进行中断时间序列分析，以比较HB21实施前后加巴喷丁类药物、苯二氮䓬类药物和肌肉松弛剂的月均使用者数量和处方数量的变化。
法律实施后，每1000名患者中加巴喷丁类药物使用者的月比例立即增加了6%（相对风险：1.06；95%置信区间：1.02，1.11），加巴喷丁类药物处方的月比例立即增加了11%（相对风险：1.11；95%置信区间：1.04，1.18）。然而，法律实施后，我们观察到肌肉松弛剂和苯二氮䓬类药物使用者的月比例趋势显著下降。
HB21实施后，加巴喷丁类药物的患者和处方数量增加，而接受苯二氮䓬类药物和肌肉松弛剂的患者减少。在先前的研究中，阿片类药物处方限制法律显示可减少阿片类药物的使用，但这项研究表明，这些法律可能也会对本不打算受影响的辅助性药物的使用产生意想不到的后果。
