‘Delayed dispensing’ of opioid prescriptions is happening in the US

Patients may use drugs for reasons or timeframes other than those intended by the prescriber, according to the study.

The “delayed dispensing” of opioid prescriptions could be an indicator that the drugs have been misused, according to a new study.

Researchers looked at how long it took between surgeons and dentists writing opioid prescriptions and when patients had them filled in 2019. They found that 1% of prescriptions were filled more than 30 days after writing, a potential source of concern, according to the study.

While the percentage is small, the actual number was 194,452 delayed-dispensing prescriptions, and that would translate to more than 260,000 opioid prescriptions per year if generalized to all surgical and opioid prescriptions nationwide. , according to a press release.

“Our results suggest that some patients use opioids from surgeons and dentists for a reason or for a period other than that intended by the prescriber,” said lead author Kao-Ping Chua, MD, PhD, of the Institute. of Michigan Health Policy and Innovation, said in a press release. “These are two forms of prescription opioid abuse, which in turn are an important risk factor for opioid overdose.”

The study, “Estimation of the Prevalence of Delayed Dispensing Among Opioid Prescriptions From US Surgeons and Dentists,” was published in the journal Open JAMA Network.

Researchers looked at the number of opioid prescriptions across the country for 2019 and state laws with time limits for dispensing different types of controlled substances.

In 2019, 18 states allowed prescriptions for Schedule II opioids and other controlled substances — those most at risk of being diverted for misuse — to be filled for up to six months after they were written. Seven other states – Alaska, Colorado, Florida, Indiana, Montana, Ohio, Tennessee and the District of Columbia – have allowed the drugs to be dispensed up to 1 year after prescription. Four states — Alabama, Connecticut, Idaho and South Dakota — have imposed no time limits on dispensing prescriptions for Schedule II opioids.

“It is baffling that states allow controlled substance prescriptions to be filled so long after they are written,” Chua said in the press release. By comparison, deferred distribution “dropped rapidly” in Minnesota in July 2019 when that state banned distribution more than 30 days after writing.

Chua and the co-authors noted that state and federal laws governing expiration times for prescriptions of controlled substances may be partly responsible. Tightening state laws could be one way to prevent or reduce delivery delays, but it could also inadvertently harm patients taking chronic pain medication.

Other suggested options for controlling delayed delivery:

  • Laws could limit the distribution time window only when opioids are written for acute pain.
  • Hospitals could modify electronic health records so that default prescription signatures direct pharmacists to refrain from dispensing more than 30 days after writing.
  • Prescribing clinicians could manually add these instructions to their signatures.
  • Insurers could refuse to cover prescriptions written by surgeons or dentists if they are presented more than 30 days after they were written.

It was unclear what the long-term effects of Minnesota’s legal delay would be. This law was repealed on March 29, 2020, at the start of the COVID-19 pandemic.

The study used data from the National Pharmacy Database and looked at more than 20.85 million prescriptions. Of these, more than 16.28 million, or 78.1%, have been dispensed at the time of writing; more than 2.92 million were distributed within one to three days; and more than 1.15 million were distributed within four to 14 days of writing, according to the study.

Among clinicians, the proportion of prescriptions with delayed filling was generally higher for family medicine clinicians (7.1%), nurse practitioners (6.3%), specialists in internal medicine (5.6%) and physician assistants (5.5%) than for surgeons (1%) and dentists (0.9%), according to the study.

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