WVU researchers study effects of new opioid law on doctors, pharmacists, patients

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Credit: West Virginia University

In 2017, West
Virginia healthcare providers wrote 81.3 opioid prescriptions for every 100
state residents, according to the Centers for Disease Control and Prevention.
The national average? Just 58.7.

Treah
Haggerty
and Cara Sedney–researchers
in the West Virginia University School of Medicine–are studying
how a new West Virginia law has changed the way healthcare providers prescribe opioids.
Working with the state’s Board of Pharmacy, they’re examining prescription
practices before and after the law took effect on June 7, 2018, and pinpointing
differences.

They’ll also interview healthcare providers, pharmacists and patients across
West Virginia to understand how the law has shaped their experiences
prescribing, dispensing and taking opioids.

“A lot of states have made this sort of law in various iterations, and
we don’t really know if they work,” said Sedney, an associate professor in the Department of Neurosurgery and the Rockefeller Neuroscience Institute. “Because we
have a dataset before and after the law went into effect, we can figure out if
the law made any impact. If it works–or if it doesn’t work–we want to know why
and how.”

The National Institute on Drug Abuse, a division of the National
Institutes of Health, has funded their project. Sedney and Haggerty also receive support from the West Virginia Clinical and Translational Science
Institute
.

Talking to ‘all
of the players’

The law originated with Senate Bill 273, which Gov. Jim Justice
proposed. It curtailed the initial amount of opioids that a physician can
prescribe a patient, under various circumstances.

For example, someone who visits an emergency room can’t receive more
than a three days’ supply, but someone who undergoes surgery can get up to
seven days’ worth. Neither can have the prescription refilled without a
physician’s reassessment. Chronic-pain patients who have used opioids for more
than five years are not subject to the restrictions.

To see how the law has influenced opioid prescribing, Haggerty and
Sedney will assess prescription data from the Board of Pharmacy. The data will
encompass the 15 months that preceded the law’s enactment and the 15 months
that followed it. The researchers will track the number of opioid
prescriptions, the number of pills in each prescription and other factors over
time.

They will also interview patients, pharmacists and healthcare
providers to discern how the policy changes have affected them individually. “If
you think about it, anytime a physician writes a prescription, a pharmacist
actually gives it to the patient,” Sedney said. “It forms this triad, and we’re
trying to talk to all of the players.”

They’ll collaborate with harm reduction clinics to “get some stories
from patients who are active users,” said Haggerty, an associate professor who
directs the Rural
Scholars Program
for the Department of Family Medicine. “We’ll also
be interviewing chronic-pain patients in mostly primary-care settings, through
the West Virginia
Practice-Based Research Network
.”

Maximizing
benefits, minimizing drawbacks

People who take opioids for a long time face a higher risk of becoming
physically dependent on them. Keeping opioid prescriptions short may help lower
that risk. But it’s possible that the law’s restrictions may also have
negative, unintended consequences.

“I do spine surgeries, and many of my patients realistically need more
than seven days of opiates after certain surgeries,” Sedney said. “I operate on
people from all over the state. Say they drove five hours to come have their
surgery. I can give them a week’s worth of opiates, and then they have to come
back to get another prescription in a week. So they have to make that five-hour
drive again, after having surgery.”

Because the patient hasn’t recovered from surgery yet, the return trip
can be painful–particularly if the patient has to travel the bumpy, winding
roads that branch across rural West Virginia.

Sedney continued, “At the other end of the spectrum, I know someone
who called the dentist and asked for ibuprofen, and the dentist prescribed
Tylenol 4.”

Tylenol 4 contains codeine, an opioid.

“He didn’t even want it,” she said.

The ‘misery’
of quitting cold turkey

Prescribing opioids
too liberally–including to patients who don’t need them–cultivates dependence.
And once someone is physically dependent on an opioid, quitting it is especially
hard.

That’s the case whether someone has been taking the drug as directed
by a doctor, in opposition to a doctor’s instructions or without a doctor’s
knowledge at all. It’s also true regardless of how someone got the drug: by picking
it up at a pharmacy, buying it from a neighbor or stealing it from a relative’s
medicine cabinet.

“If somebody does have a dependence on an opiate, and we take them off
the opiate abruptly, they can be put into a very desperate situation,” Haggerty
said. “Somebody who’s actually a really good person can cross that bound into
doing something illegal or getting into harder drugs off the street. That’s
always a concern. That’s why we need to get the story straight from the
patients.”

Symptoms of opioid withdrawal are far more severe than the headache
coffee drinkers get when they forego caffeine.

“It makes you very, very miserable: horrible pain, nausea, sweats,
diarrhea,” Sedney said. “It’s rarely life-threatening, but it makes you feel
like you are going to die.”

What she and Haggerty learn may suggest ways policymakers–in West
Virginia and elsewhere–can assist people in pain while also preventing opioid
dependence and the “misery” of withdrawal.

“What things were helpful about the law? What was not helpful?”
Haggerty said. “Everything we find out may not be generalizable to every state,
but there’s going to be information we gather that can be useful as other
states come up with their own prescribing-type laws.”

Research reported in this
publication was supported by the National Institute on Drug Abuse of the
National Institutes of Health, under Award Number 1R21DA049861-01, and the West
Virginia Clinical and Translational Science Institute. WVCTSI is funded by
an IDeA Clinical and Translational grant from the National Institute of General
Medical Sciences, under Award Number U54GM104942, to support the mission of
building clinical and translational research infrastructure and capacity to
impact health disparities in West Virginia. The content is solely
the responsibility of the authors and does not necessarily represent the
official views of NIH or CTSI.

Media Contact
Cassie Thomas
[email protected]

Original Source

https://wvutoday.wvu.edu/stories/2019/10/24/wvu-researchers-study-effects-of-new-opioid-law-on-doctors-pharmacists-patients

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