• Yun Shen, Juan M Hincapie-Castillo, Scott M Vouri, Marvin A Dewar, Jill M Sumfest, and Amie J Goodin.
• Department of Pharmaceutical Outcomes & Policy, University of Florida, Gainesville, FL; Center for Drug Evaluation and Safety, University of Florida, Gainesville, FL.
• Pain Physician. 2021 Sep 1; 24 (6): 417-424.

BackgroundFlorida House Bill 21 (HB21) was implemented in July 2018 to limit Schedule II opioids prescriptions for patients with acute pain to a 3-day supply. Little is known about the potential unintended effects that such opioid restriction policies may have on chronic pain patients, who are exempt from the law.ObjectiveWe aimed to evaluate the effect of HB21 on opioid utilization measures among a cohort of chronic opioid therapy (COT) patients.Study DesignA quasi-experimental design with interrupted time series analyses.SettingPharmacy claims from January 1, 2015 to June 31, 2019 from a large employer-based health plan in Florida.MethodsCOT patients were those who received a ≥ 70 days' supply of opioids in the prior 90 days, representing 15,310 patients. Interrupted time series analyses were conducted to compare the following monthly measures among COT patients before and after HB21 implementation: 1) number of COT patients, 2) daily Morphine Milligram Equivalents [MMEs], 3) days' supply of prescriptions.ResultsThere was a significant 25% reduction in the trend (pre-HB21 RR: 0.95, 95% CI: 0.93, 0.96 versus post-HB21 RR: 0.70, 95% CI: 0.65, 0.76) and an 8% immediate decrease (RR: 0.92, 95% CI: 0.88, 0.97) in the monthly prevalence of COT patients after HB21 implementation. However, no significant change was observed in trends for monthly number of days supplied per prescription, monthly MMEs per COT patient-day, or total MMEs per prescription.LimitationsOur study used data from employer-based private health insurance and did not include a longer post-policy period to adjust for implementation lag.ConclusionFewer patients received COT after HB21; however, patients who continued to receive COT experienced no significant changes in their regimen. The study did not assess whether COT patients were appropriately tapered or if therapeutic alternatives were initiated for new chronic pain patients.

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