A controlled study of the effects of state surveillance on indicators of problematic and non-problematic benzodiazepine use in a Medicaid population

Dennis Ross-Degnan, Linda Simoni-Wastila, Jeffrey S. Brown, Xiaoming Gao, Connie Mah, Leon E. Cosler, Thomas Fanning, Peter Gallagher, Carl Salzman, Richard I. Shader, Thomas Inui, Stephen B. Soumerai

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

Objective: Benzodiazepines (BZs) are safe, effective drugs for treating anxiety, sleep, bipolar, and convulsive disorders, but concern is often expressed about their overuse and potential for abuse. We evaluated the effects of physician surveillance through a Triplicate Prescription Program (TPP) on problematic and non-problematic BZ use. Method: This study uses interrupted time series analyses of BZ use in the New York (intervention) and New Jersey (control) Medicaid programs for 12 months before and 24 months after the New York BZ TPP. The regulation required NY physicians to order BZs on triplicate prescription forms with one copy forwarded by pharmacies to a state surveillance unit. Study participants were community-dwelling persons over age 18 continuously enrolled between January 1988 and December 1990 in New York (n = 125,837) or New Jersey Medicaid (n = 139,405). Results: During the baseline year, 20.2% of New York and 19.3% of New Jersey cohort members received at least one BZ prescription. After the TPP, there was a sudden, sustained reduction in BZ use of 54.8% (95% CI = [51.4%, 58.3%]) in New York with no changes in New Jersey. Significantly greater reductions were experienced by young women, and persons living in zip codes that were urban, predominantly Black, or with a high density of poor households. Increases in potential substitute medications were modest. At baseline, nearly 60% of BZ recipients had no evidence of potentially problematic use. Despite a somewhat greater likelihood of discontinuation of BZ therapy among those with potentially problematic use, the largest impact of the TPP was a substantially greater relative reduction in access to BZs among non-problematic users. Conclusions: State-mandated physician surveillance dramatically reduces BZ use with limited substitution of alternative drugs, lowers rates of possible abuse, but may severely limit non-problematic BZ use.

Original languageEnglish (US)
Pages (from-to)103-123
Number of pages21
JournalInternational Journal of Psychiatry in Medicine
Volume34
Issue number2
DOIs
StatePublished - 2004
Externally publishedYes

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Medicaid
Benzodiazepines
Population
Prescriptions
Physicians
Drug Substitution
Independent Living
Pharmacies
Bipolar Disorder
Sleep
Anxiety

Keywords

  • Benzodiazepines
  • Drug regulation
  • Interrupted time series
  • Longitudinal studies
  • Medicaid
  • Pharmaceutical policy

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

A controlled study of the effects of state surveillance on indicators of problematic and non-problematic benzodiazepine use in a Medicaid population. / Ross-Degnan, Dennis; Simoni-Wastila, Linda; Brown, Jeffrey S.; Gao, Xiaoming; Mah, Connie; Cosler, Leon E.; Fanning, Thomas; Gallagher, Peter; Salzman, Carl; Shader, Richard I.; Inui, Thomas; Soumerai, Stephen B.

In: International Journal of Psychiatry in Medicine, Vol. 34, No. 2, 2004, p. 103-123.

Research output: Contribution to journalArticle

Ross-Degnan, D, Simoni-Wastila, L, Brown, JS, Gao, X, Mah, C, Cosler, LE, Fanning, T, Gallagher, P, Salzman, C, Shader, RI, Inui, T & Soumerai, SB 2004, 'A controlled study of the effects of state surveillance on indicators of problematic and non-problematic benzodiazepine use in a Medicaid population', International Journal of Psychiatry in Medicine, vol. 34, no. 2, pp. 103-123. https://doi.org/10.2190/8FR4-QYY1-7MYG-2AGJ
Ross-Degnan, Dennis ; Simoni-Wastila, Linda ; Brown, Jeffrey S. ; Gao, Xiaoming ; Mah, Connie ; Cosler, Leon E. ; Fanning, Thomas ; Gallagher, Peter ; Salzman, Carl ; Shader, Richard I. ; Inui, Thomas ; Soumerai, Stephen B. / A controlled study of the effects of state surveillance on indicators of problematic and non-problematic benzodiazepine use in a Medicaid population. In: International Journal of Psychiatry in Medicine. 2004 ; Vol. 34, No. 2. pp. 103-123.
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abstract = "Objective: Benzodiazepines (BZs) are safe, effective drugs for treating anxiety, sleep, bipolar, and convulsive disorders, but concern is often expressed about their overuse and potential for abuse. We evaluated the effects of physician surveillance through a Triplicate Prescription Program (TPP) on problematic and non-problematic BZ use. Method: This study uses interrupted time series analyses of BZ use in the New York (intervention) and New Jersey (control) Medicaid programs for 12 months before and 24 months after the New York BZ TPP. The regulation required NY physicians to order BZs on triplicate prescription forms with one copy forwarded by pharmacies to a state surveillance unit. Study participants were community-dwelling persons over age 18 continuously enrolled between January 1988 and December 1990 in New York (n = 125,837) or New Jersey Medicaid (n = 139,405). Results: During the baseline year, 20.2{\%} of New York and 19.3{\%} of New Jersey cohort members received at least one BZ prescription. After the TPP, there was a sudden, sustained reduction in BZ use of 54.8{\%} (95{\%} CI = [51.4{\%}, 58.3{\%}]) in New York with no changes in New Jersey. Significantly greater reductions were experienced by young women, and persons living in zip codes that were urban, predominantly Black, or with a high density of poor households. Increases in potential substitute medications were modest. At baseline, nearly 60{\%} of BZ recipients had no evidence of potentially problematic use. Despite a somewhat greater likelihood of discontinuation of BZ therapy among those with potentially problematic use, the largest impact of the TPP was a substantially greater relative reduction in access to BZs among non-problematic users. Conclusions: State-mandated physician surveillance dramatically reduces BZ use with limited substitution of alternative drugs, lowers rates of possible abuse, but may severely limit non-problematic BZ use.",
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AU - Ross-Degnan, Dennis

AU - Simoni-Wastila, Linda

AU - Brown, Jeffrey S.

AU - Gao, Xiaoming

AU - Mah, Connie

AU - Cosler, Leon E.

AU - Fanning, Thomas

AU - Gallagher, Peter

AU - Salzman, Carl

AU - Shader, Richard I.

AU - Inui, Thomas

AU - Soumerai, Stephen B.

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N2 - Objective: Benzodiazepines (BZs) are safe, effective drugs for treating anxiety, sleep, bipolar, and convulsive disorders, but concern is often expressed about their overuse and potential for abuse. We evaluated the effects of physician surveillance through a Triplicate Prescription Program (TPP) on problematic and non-problematic BZ use. Method: This study uses interrupted time series analyses of BZ use in the New York (intervention) and New Jersey (control) Medicaid programs for 12 months before and 24 months after the New York BZ TPP. The regulation required NY physicians to order BZs on triplicate prescription forms with one copy forwarded by pharmacies to a state surveillance unit. Study participants were community-dwelling persons over age 18 continuously enrolled between January 1988 and December 1990 in New York (n = 125,837) or New Jersey Medicaid (n = 139,405). Results: During the baseline year, 20.2% of New York and 19.3% of New Jersey cohort members received at least one BZ prescription. After the TPP, there was a sudden, sustained reduction in BZ use of 54.8% (95% CI = [51.4%, 58.3%]) in New York with no changes in New Jersey. Significantly greater reductions were experienced by young women, and persons living in zip codes that were urban, predominantly Black, or with a high density of poor households. Increases in potential substitute medications were modest. At baseline, nearly 60% of BZ recipients had no evidence of potentially problematic use. Despite a somewhat greater likelihood of discontinuation of BZ therapy among those with potentially problematic use, the largest impact of the TPP was a substantially greater relative reduction in access to BZs among non-problematic users. Conclusions: State-mandated physician surveillance dramatically reduces BZ use with limited substitution of alternative drugs, lowers rates of possible abuse, but may severely limit non-problematic BZ use.

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