Impact of Florida's prescription drug monitoring program and pill mill law on high-risk patients: A comparative interrupted time series analysis

Pharmacoepidemiol Drug Saf. 2018 Apr;27(4):422-429. doi: 10.1002/pds.4404. Epub 2018 Feb 28.


Purpose: We quantified the effects of Florida's prescription drug monitoring program and pill mill law on high-risk patients.

Methods: We used QuintilesIMS LRx Lifelink data to identify patients receiving prescription opioids in Florida (intervention state, N: 1.13 million) and Georgia (control state, N: 0.54 million). The preintervention, intervention, and postintervention periods were July 2010 to June 2011, July 2011 to September 2011, and October 2011 to September 2012. We identified 3 types of high-risk patients: (1) concomitant users: patients with concomitant use of benzodiazepines and opioids; (2) chronic users: long-term, high-dose, opioid users; and (3) opioid shoppers: patients receiving opioids from multiple sources. We compared changes in opioid prescriptions between Florida and Georgia before and after policy implementation among high-risk/low-risk patients. Our monthly measures included (1) average morphine milligram equivalent per transaction, (2) total opioid volume across all prescriptions, (3) average days supplied per transaction, and (4) total number of opioid prescriptions dispensed.

Results: Among opioid-receiving individuals in Florida, 6.62% were concomitant users, 1.96% were chronic users, and 0.46% were opioid shoppers. Following policy implementation, Florida's high-risk patients experienced relative reductions in morphine milligram equivalent (opioid shoppers: -1.08 mg/month, 95% confidence interval [CI] -1.62 to -0.54), total opioid volume (chronic users: -4.58 kg/month, CI -5.41 to -3.76), and number of dispensed opioid prescriptions (concomitant users: -640 prescriptions/month, CI -950 to -340). Low-risk patients generally did not experience statistically significantly relative reductions.

Conclusions: Compared with Georgia, Florida's prescription drug monitoring program and pill mill law were associated with large relative reductions in prescription opioid utilization among high-risk patients.

Keywords: chronic opioid users; concomitant users of benzodiazepines and opioids; long-term opioid therapy; opioid shoppers; pharmacoepidemiology; pill mill law; prescription drug abuse; prescription drug monitoring program; time series analysis.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Analgesics, Opioid / administration & dosage*
  • Analgesics, Opioid / adverse effects
  • Databases, Factual / statistics & numerical data
  • Drug Prescriptions / statistics & numerical data
  • Drug Utilization / legislation & jurisprudence
  • Drug Utilization / statistics & numerical data
  • Female
  • Florida
  • Georgia
  • Humans
  • Interrupted Time Series Analysis
  • Male
  • Middle Aged
  • Prescription Drug Misuse / legislation & jurisprudence
  • Prescription Drug Misuse / prevention & control*
  • Prescription Drug Monitoring Programs / legislation & jurisprudence*
  • Prescription Drug Monitoring Programs / statistics & numerical data
  • Prescription Drugs / administration & dosage*
  • Prescription Drugs / adverse effects


  • Analgesics, Opioid
  • Prescription Drugs