Athens, Ga. – Researchers at the University of Georgia will use a grant from the National Institute on Drug Abuse, part of the National Institutes of Health, to study the effect of public policy aimed at limiting potential misuse and potentially inappropriate prescribing of opioids in vulnerable populations.
The research grant provides $675,000 over three years to fund the study.
In the last few months, the federal government has mandated stricter warning labels for prescription painkillers and handed down the first-ever set of practitioner guidelines for prescribing painkillers. Also, U.S. Surgeon General Vivek Murthy’s office is planning to release the first-ever Surgeon General’s Report on substance use, addiction and health this year.
The Centers for Disease Control and Prevention reports that almost 29,000 people died by opioid overdose in the U.S. in 2014, a rate that has quadrupled since 1999.
Research suggests the steady increase in opioid overdoses is linked to both poor prescribing methods from physicians, like over-prescribing and refilling too soon or often, and patient prescription misuses. Both have been linked to heroin use, often seen as a cheap, accessible alternative to prescription medications.
In 2013, Georgia became one of the few states to enact a policy to try to curb opioid addiction. The state is doing so by adapting its Medicaid program to more carefully monitor prescription opioid refills, limiting the number of prescriptions for opioids a patient can receive per month, and ensuring that certain medications are not used at the same time as opioids. However, until now, the policy’s effectiveness has not been tested.
In the UGA College of Pharmacy, assistant professor Jayani Jayawardhana and professor Matthew Perri are leading the investigation to study the impact of the Medicaid policy change.
The study focuses on two aspects of opioid prescribing practices that potentially lead to addiction—prescribing too much and refilling too soon—both of which are risk factors for patient misuse. If prevented, it could lead to lower addiction rates and decreased associated health care costs, according to the research hypothesis.
The research comprises a statewide study of opioid prescriptions and overdoses within Georgia’s Medicaid population from 2009 to 2014. North Carolina will be used as a control group, as the state has not implemented a policy change and has a similar Medicaid population.
Jayawardhana and Perri are using Medicaid pharmacy prescription drug claims data because it provides opioid-use data from a vulnerable population often comprised of people from low socio-economic backgrounds or with substance use disorders. For the five years of data, the researchers will be poring through over 50 million prescriptions from Georgia alone.
“The study was developed so Georgia Medicaid could effectively evaluate the full impact of its policy changes on patients’ health outcomes,” Perri said.
“The Georgia policy provided us with a natural experiment, but no one has studied the effect of the implementation in curbing potential opioid misuse and inappropriate prescribing,” Jayawardhana said. “Our goal is to evaluate this policy—is it doing what it’s meant to do?”
The study will examine data from before and after the Georgia policy to track trends and evaluate its impact on several variables: overprescribing of opioids by health care providers and misuse by patients; patterns in patients’ use of health care facilities, like doctor and emergency room visits; and deaths by opioid overdose.
“Having a policy for the sake of having a policy is not enough,” Jayawardhana said. “If it’s not achieving what it’s supposed to, we need to change it.”
Jayawardhana said this research is unique not only because it hasn’t been done before and is vital to determine the efficacy of opioid policy, but it can also help other states find cost-effective ways to curb prescription misuse.
“These policies are extremely low cost; and, if it’s effective, other states can adopt this and put it into place,” she said. “By looking at Georgia, we can provide policy strategies to curb the national crisis.”
The study was inspired by Perri’s longstanding work with Georgia Medicaid, including his work as chair of the Georgia Drug Utilization Review Board from 2003-2010.
Plus, “Dr. Jayawardhana’s background in health economics and policy, as well as public health, was critical to the development of the study methodology,” Perri said.
In addition to Perri and Jayawardhana, the research team is comprised of Amanda Abraham, Henry Young and David Bradford, in the UGA College of Pharmacy and School of Public and International Affairs. As co-investigators, the researchers contributed to the grant’s development and will play an important role in its completion.
The research is being supported by the National Institute on Drug Abuse of the NIH under award number R01DA039930.