Consequences of 2014 legislation on controlled substance dispensing patterns and utilization of the Indiana prescription drug monitoring program: a three year review

2019-10-16T16:30:21Z (GMT) by Kristin R Villa
The misuse of prescription controlled substances is a matter of growing concern in the United States. The National Institute on Drug Abuse (NIDA) defines misuse as “taking a medication in a manner or dose other than prescribed; taking someone else’s prescription, even if for a legitimate medical complaint such as pain; or taking a medication to feel euphoria (i.e., to get high).” This broad definition provides a comprehensive understanding of drug misuse and includes many different behaviors when taking medication. Specifically, the misuse of opioids has been recognized as a public health emergency, but it is not the only category of controlled substances misused. According to the 2016 National Survey on Drug Use and Health (NSDUH), approximately 6.2 million Americans had misused prescription drugs within the last month and 18.7 million within the last year, the second-highest reported incidence of misuse for any drug category after marijuana. The therapeutic classes of medications associated with prescription drug misuse include benzodiazepines, stimulants, opioid pain relievers, and sedative-hypnotics. To combat the misuse of these prescription medications, new laws and regulations have been put in place at both federal and state levels.

The objectives of this study were to assess whether controlled substance dispensing in Indiana has changed over the three-year study period when changes in legislation around hydrocodone combination product rescheduling and INSPECT reporting occurred, to assess practitioner use of the INSPECT program changed over the three-year study period, and to assess whether the focus on opioid misuse led practitioners to use the INSPECT program more for opioid-based substances.

37,264, 971 dispensations, and 7,829,714 practitioner queries were used for analysis. Results indicate policy changes had mixed results on dispensations. Hydrocodone rescheduling had no impact on dispensing, while INSPECT reporting changes had a significant impact on dispensing. When examining specific drug classes, the impact of policy changes was less clear. In addition, results indicated practitioner use of INSPECT is increasing over the three-year study period, but policy changes did not impact usage. Specific practitioner type results were similar. Finally, results indicate there is a difference in INSPECT usage across drug class.

It can be definitively stated that policies have impacted controlled substance dispensing and use of INSPECT in Indiana. This study provides strong evidence to support examining controlled substance dispensations and PDMP usage on a larger scale than just a single drug class. This study also illustrates that many substances make up controlled substance dispensing in Indiana, and though opioids are currently drugs of concern, other products are also dispensed in significant numbers.