After implementation of the Risk Evaluation and Mitigation Strategy (REMS), the mortality rate associated with extended-release and long-acting (ER/LA) opioid analgesics decreased in 3 states, according to a study published in Pain Medicine.

For this study, all drug poisoning deaths that occurred in Florida, Oregon, and Washington, as assessed from state vital records offices and the Researched Abuse, Diversion, and Addiction-Related Surveillance System medical examiner program, were taken into account. The researchers used cause of death literal text from death certificates and rules-based natural language processing to identify individual opioid active pharmaceutical ingredients (APIs) involved in each death.

Population-adjusted and prescriptions dispensed-adjusted mortality rates for all ER/LA opioid analgesic and individual opioid APIs, and death rates before and after implementation of the REMS were calculated. These rates were compared with those associated with 2 APIs that had little or no inclusion in the REMS (benzodiazepines and hydrocodone).

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The mean ER/LA opioid analgesic population-adjusted mortality rate was found to have decreased in Florida (P =.003), Oregon (P =.003), and Washington (P <.001). Rates associated with the use of benzodiazepines and hydrocodone decreased in a statistically similar way.

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After adjusting for prescription volume, the ER/LA opioid analgesic mortality rate was found to have decreased in all 3 states but the decrease remained significant only in Washington state (P <.001).

“This study illustrates that the ER/LA REMS initiative, in conjunction with other concurrent interventions at national and state levels, is temporally associated with a decrease in mortality where opioids are involved,” the researchers noted.

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Black JC, Bau GE, Rosen T, et al. Changes in mortality involving extended-release and long-acting opioids after implementation of a risk evaluation and mitigation strategy. [published online March 25, 2019]. Pain Med. doi:10.1093/pm/pnz031