N/A
N=5,411
Comparing State Payer Strategies to Prevent Unsafe Opioid Prescribing
Opioid Use · Opioid-Related Disorders
Bottom Line
View on ClinicalTrials.gov: NCT03932799 ↗Enrolled (actual)
5,411
Serious AEs
—
Results posted
Sep 2023
Primary outcome: Primary: Subacute Phase - More Than 7 Days of Opioids — 1.9; 12.2 % of participants — p=<.001
Study Design & Population
- Study type
- Observational
- Phase
- N/A
- Interventions
- Prospective prior authorization (PA) with hard stops in Washington (Other); Retrospective review (RR) with prescriber notification in Ohio (Other)
- Age
- Adult, Older Adult · 18+ yrs
- Sex
- All
- Sponsor
- University of Washington
- Primary completion
- Mar 2022
Outcome Measures
| Outcome | Result | p-value |
|---|---|---|
| PRIMARY Subacute Phase - More Than 7 Days of Opioids |
1.9; 12.2 | <.001 sig |
| PRIMARY Chronic Phase - Composite (Meeting ≥1 of the 3 Chronic Phase Metrics) |
1.2; 2.4; 0.9; 2.4; 0.8; 2.1 | .43 |
| PRIMARY Chronic Phase - Chronic Opioids (≥60 Days' Supply) |
0.0; 1.7; 0.0; 2.3; 0.0; 1.9 | — |
| PRIMARY Chronic Phase - Concurrent (Concurrent Sedatives/Hypnotics and Opioids on ≥1 Day) |
0.0; 0.4; 0.0; 0.1; 0.0; 0.1 | — |
| PRIMARY Chronic Phase - High Dose (Average of ≥50 Morphine Equivalent Daily Dose [MEDD] Among All Days With Opioids) |
1.2; 1.0; 0.9; 0.5; 0.8; 0.4 | .002 sig |
| SECONDARY ≥30% Decrease in Pain Intensity/Interference (PEG-3) |
1001; 151 | .84 |
| SECONDARY Anxious Symptoms (PHQ-4) |
487; 79 | .88 |
| SECONDARY Depressive Symptoms (PHQ-4) |
322; 64 | .15 |
| SECONDARY Global Improvement (GIC) |
1413; 222 | .38 |
| SECONDARY Disability - Activity Limitation |
281; 49; 220; 37; 246; 56 | .12 |
| SECONDARY Not Working for Pay |
599; 107 | .22 |
| SECONDARY On Time Loss (Not Working) |
209; 43 | .02 sig |
| SECONDARY Earning Less Than Before Injury |
819; 129 | .10 |
| SECONDARY Opioid Overdose/Adverse Effects |
2; 0 | — |
| SECONDARY Quality of Life (EuroQol EQ-5D) |
0.81; 0.79 | .53 |
| SECONDARY Satisfaction With Overall Treatment |
0.98; 0.81 | .053 |
| SECONDARY Satisfaction With Pain-related Treatment |
0.88; 0.66 | .01 sig |
Summary
This study examines the comparative effectiveness of opioid review programs in reducing unsafe opioid prescribing in two states: prospective prior authorization (PA) with hard stops in Washington and retrospective review (RR) with prescriber notification in Ohio.
Eligibility Criteria
Inclusion Criteria
Aims 1 and 2:
- File a new accepted State Fund claim
- Fill at least one opioid prescription, paid for by workers' compensation, during the first 6 weeks after date of injury
Aim 3 key informants
- Policy makers and stakeholders who were involved in the creation and implementation of the Washington or Ohio opioid review program.
Aim 3 individual in-depth interviews
- Providers that had at least one patient whose opioid prescriptions paid for through workers' compensation had been reviewed in accordance with the state's opioid review program.
- Patients that had an opioid prescription for at least 6 weeks paid for by workers' compensation or whose prescription payments have been reviewed in accordance with the state's opioid review program.
Exclusion Criteria (Aims 1 and 2):
- Under 18 years of age
- Current cancer diagnosis
- Surveys only: do not speak English or Spanish, physically or mentally incapable of completing the survey, incarcerated, deceased
Data sourced from ClinicalTrials.gov (NCT03932799). Outcome figures and adverse-event rates are extracted automatically from the registry's posted results and are provided for clinician reference, not as a substitute for the primary publication.