ArticleSubstance abuse2018
Effect of a high dosage opioid prior authorization policy on prescription opioid use, misuse, and overdose outcomes.
Article in Substance abuse, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 2 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
20 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Association between supportive interventions and healthcare utilization and outcomes in patients on long-term prescribed opioid therapy presenting to acute healthcare settings: a systematic review and meta-analysis.BMC emergency medicine · 2021Pooled it
- A Rapid Review of the Impact of Systems-Level Policies and Interventions on Population-Level Outcomes Related to the Opioid Epidemic, United States and Canada, 2014-2018.Public health reports (Washington, D.C. : 1974)Pooled it
- Responsible AI for safer opioid risk management in older adults.npj health systems · 2026Article
- Outcomes After a Statewide Policy to Improve Evidence-Based Treatment of Back Pain Among Medicaid Enrollees in Oregon.Journal of general internal medicine · 2025Article
- Impacts of State-Level Opioid Review Programs on Injured Workers and Their Health Care Providers: A Qualitative Study in Washington and Ohio.The Milbank quarterly · 2024Article
- Population-Based Opioid Prescribing and Overdose Deaths in the USA: an Observational Study.Journal of general internal medicine · 2023Observational
- Medicare Part D Coverage Restrictions and Patient Cost-Sharing for Opioids Commonly Used for Cancer Pain, 2015-2021.JCO oncology practice · 2022Article
- Evaluating opioid analgesic prescribing limits: A narrative review.Pharmacoepidemiology and drug safety · 2022Review
- Association of opioid utilization management with prescribing and overdose.The American journal of managed care · 2022Article
- Evaluation of a Medicaid performance improvement project to reduce high-dose opioid prescriptions.BMC health services research · 2022Article
- Article
- Association of 3 CDC opioid prescription guidelines for chronic pain and 2 payer pharmacy coverage changes on opioid initiation practices.Journal of managed care & specialty pharmacy · 2021Article
- Impact of drug utilization management policy on prescription opioid use in Georgia Medicaid.Journal of pharmaceutical health services research : an official journal of the Royal Pharmaceutical Society of Great Britain · 2021Article
- Restrictive opioid prescribing policies and evolving risk environments: A qualitative study of the perspectives of patients who experienced an accidental opioid overdose.The International journal on drug policy · 2021Article
- Changes in early high-risk opioid prescribing practices after policy interventions in Washington State.Health services research · 2021Article
- A comparison of trends in opioid dispensing patterns between Medicaid pharmacy claims and prescription drug monitoring program data.Pharmacoepidemiology and drug safety · 2020Article
- The Association of State Opioid Misuse Prevention Policies With Patient- and Provider-Related Outcomes: A Scoping Review.The Milbank quarterly · 2020Article
- Impact of delisting high-strength opioid formulations from a public drug benefit formulary on opioid utilization in Ontario, Canada.Pharmacoepidemiology and drug safety · 2019Article
- Damaging State Legislation Regarding Opioids: The Need To Scrutinize Sources Of Inaccurate Information Provided To Lawmakers.Journal of pain research · 2019Article
- Reduction of Long-Term Opioid Prescribing for Back Pain in Community Health Centers After a Medicaid Policy Change.Journal of the American Board of Family Medicine : JABFMArticle
Corrections and comments
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Authors and funding
8 authors.
Funding
Abstract
backgroundHigh dosage opioid use is a risk factor for opioid-related overdose commonly cited in guidelines, recommendations, and policies. In 2012, the Oregon Medicaid program developed a prior authorization policy for opioid prescriptions above 120 mg per day morphine equivalent dose (MED). This study aimed to evaluate the effects of that policy on utilization, prescribing patterns, and health outcomes.
methodsUsing administrative claims data from Oregon and a control state (Colorado) between 2011 and 2013, we used difference-in-differences analyses to examine changes in utilization, measures of high risk opioid use, and overdose after introduction of the policy. We also evaluated opioid utilization in a cohort of individuals who were high dosage opioid users before the policy.
resultsFollowing implementation of Oregon's high dosage policy, the monthly probability of an opioid fill over 120 mg MED declined significantly by 1.7 percentage points (95% confidence interval [CI]; -2.0% to -1.4%), whereas it increased significantly by 1.0 percentage points (95% CI 0.4% to 1.7%) for opioid fills < 61 mg MED. Fills of medications used to treat neuropathic pain also increased by 1.2 percentage points (95% CI 0.7% to 1.8%). The monthly probability of multiple pharmacy use declined by 0.1 percentage points (-0.2% to -0.0) following the prior authorization, but there were no significant changes in ED encounters or hospitalizations for opioid overdose. Among individuals who were using a high dosage opioid before the policy, there was a 20.3 percentage point (95% CI -15.3% to -25.3%) decline in estimated probability of having a high dosage fill after the policy.
conclusionsOregon's prior authorization policy was effective at reducing high dosage opioid prescriptions. While multiple pharmacy use also declined, we found no impact on opioid overdose were observed.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.