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Impact of drug utilization management policy on prescription opioid use in Georgia Medicaid.

Objective
To examine the effectiveness of changes in opioid prescription policies on opioid prescribing and health services utilization rates in Georgia Medicaid.


Methods
This study used data from the Georgia Medicaid patient enrollment, medical and pharmacy claims database from 2009 to 2014.We performed an interrupted time series analysis to examine the effect of the policy changes. Outcome measures assessed the trends in the indicators of potential inappropriate prescribing practices, including overlapping prescriptions of opioid + opioid, opioid + benzodiazepine and opioids + buprenorphine/naloxone, as well as health services utilization, including hospitalization, mean length of stay, outpatient office and emergency room visits.


Key findings
A total of 712 342 opioid users aged 18-64 were included in the study. The policies were associated with significant decreasing trend of opioid + opioid (-0.0011; 95% CI = -0.0020, -0.0002) and opioid + benzodiazepines (-0.001; 95% CI = -0.0022, -0.0006) overlapping while associated with a significant immediate decrease in and opioids + buprenorphine/naloxone after the implementations (-0.0014; 95% CI = -0.0025, -0.0003). Significant immediate decrease in level of office visits and ER visits were seen with the policy implementation (office visit: -0.2939; 95% CI = -0.5528, -0.0350, ER visit: -0.0740, 95% CI = -0.1294, -0.0185). The policies were not shown to be significantly associated with hospitalization and the mean length of inpatient stay.


Conclusions
Our analysis suggests that Georgia Medicaid opioid policies were useful to contain inappropriate opioid use.