{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T10:52:48Z","timestamp":1761562368136,"version":"3.37.3"},"reference-count":43,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2018,6,4]],"date-time":"2018-06-04T00:00:00Z","timestamp":1528070400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100005217","name":"National Center for Injury Prevention and Control","doi-asserted-by":"publisher","award":["1U011CE002500"],"award-info":[{"award-number":["1U011CE002500"]}],"id":[{"id":"10.13039\/100005217","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Addiction"],"published-print":{"date-parts":[[2018,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and aims<\/jats:title><jats:p>In response to the opioid overdose epidemic, US state Medicaid programs have adopted restrictive policies for opioid analgesics, yet effects on prescribing patterns and health outcomes are uncertain. This study aimed to examine effects of a prior authorization policy for extended\u2010release\/long\u2010acting (ER\/LA) opioids on opioid use in the Oklahoma, USA state Medicaid program.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Retrospective difference\u2010in\u2010differences design study comparing changes in opioid use in Oklahoma Medicaid to control (Oregon Medicaid).<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Oklahoma and Oregon, USA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>Medicaid beneficiaries in the Oklahoma and Oregon fee\u2010for\u2010service Medicaid programs between July 2007 and June 2009 (33\u2009724 in Oklahoma and 13\u2009520 in Oregon)<\/jats:p><\/jats:sec><jats:sec><jats:title>Measurements<\/jats:title><jats:p>The primary outcome was incident opioid\u2010naive ER\/LA opioid use. Secondary outcomes included other opioid and non\u2010opioid pain medication use. We also examined indicators of high\u2010risk prescribing (e.g. high\u2010dosage opioid use) and opioid\u2010related hospitalizations or emergency department (ED) visits.<\/jats:p><\/jats:sec><jats:sec><jats:title>Findings<\/jats:title><jats:p>The prior authorization policy was associated with a 0.7 percentage point reduction in the likelihood of incident opioid\u2010naive ER\/LA opioid use [95% confidence interval (CI)\u00a0=\u00a0\u22121.16 to \u22120.33 percentage points; 70% pre\u2010policy mean reduction, a 1.4 percentage point decrease in likelihood of any new ER\/LA opioid prescriptions (95% CI\u00a0=\u00a0\u20132.1 to \u22120.7 percentage points; 33% pre\u2010policy mean reduction) and a decline of 0.16 in total ER\/LA opioid prescriptions per enrollee (PPE) (95% CI\u00a0=\u00a0\u20130.29 to \u22120.04 PPE)]. There was a significant increase in the number of short\u2010acting opioids filled after the policy (0.36; 95% CI\u00a0=\u00a00.22\u20130.50 PPE), increases in likelihood of having overlapping opioids and benzodiazepines, but significant reductions in likelihood of having overlapping opioids. No significant changes in opioid\u2010related hospitalizations or ED visits were observed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In Oklahoma, USA's July 2008 prior authorization policy for extended\u2010release\/long\u2010acting opioids appears to have reduced the number of opioid\u2010naive patients initiating extended\u2010release\/long\u2010acting opioid use by more than half, but may also have increased short\u2010acting opioid prescriptions by 7%.<\/jats:p><\/jats:sec>","DOI":"10.1111\/add.14248","type":"journal-article","created":{"date-parts":[[2018,4,21]],"date-time":"2018-04-21T03:59:22Z","timestamp":1524283162000},"page":"1651-1660","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Effects of a prior authorization policy for extended\u2010release\/long\u2010acting opioids on utilization and outcomes in a state Medicaid program"],"prefix":"10.1111","volume":"113","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9139-6105","authenticated-orcid":false,"given":"Shellie L.","family":"Keast","sequence":"first","affiliation":[{"name":"University of Oklahoma College of Pharmacy  Oklahoma City OK USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hyunjee","family":"Kim","sequence":"additional","affiliation":[{"name":"Oregon Health and Science University  Portland OR USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard A.","family":"Deyo","sequence":"additional","affiliation":[{"name":"Oregon Health and Science University  Portland OR USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luke","family":"Middleton","sequence":"additional","affiliation":[{"name":"Oregon State University, Oregon Health and Science University  Portland OR USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"K. John","family":"McConnell","sequence":"additional","affiliation":[{"name":"Oregon Health and Science University  Portland OR USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kun","family":"Zhang","sequence":"additional","affiliation":[{"name":"Centers for Disease Control and Prevention, National Center for Injury Prevention and Control  Atlanta GA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sharia M.","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Oregon State University, Oregon Health and Science University  Portland OR USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nancy","family":"Nesser","sequence":"additional","affiliation":[{"name":"Oklahoma Health Care Authority  Oklahoma City OK USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel M.","family":"Hartung","sequence":"additional","affiliation":[{"name":"Oregon Health and Science University  Portland OR USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,6,4]]},"reference":[{"key":"e_1_2_7_2_1","unstructured":"Center for Behavioral Health Statistics and Quality. 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