Opioid prescription laws provide ‘significant but limited outcome’

Laws in 23 states that capped the number of days a Medicare enrollee could receive an initial opioid prescription may have had their intended effect, a recent study showed.

These laws, which were implemented between March 2016 and July 2018, limited the duration of first opioid prescriptions to 7 days in 17 states, 5 days in two states and 3 days in four states. They covered 43% of the U.S. population, according to John Cramer, MD, an assistant professor in the department of otolaryngology surgery at Wayne State University School of Medicine in Michigan, and colleagues.

With the impact of the laws remaining “poorly misunderstood,” the researchers used data from the Medicare Part D Prescriber Public Use File gathered between Jan. 1, 2013, and Dec. 31, 2018, to assess opioid prescribing patterns before and after the laws were implemented. The analysis was performed with a difference-in-differences model with state-level effects. The results were adjusted for state-level differences based on data from the U.S. Census and the National Survey on Drug Use and Health.

The findings, published in JAMA Internal Medicine, showed that the number of days an opioid was prescribed for each Medicare enrollee dropped by a mean of 11.6 days during the 5-year period, compared with a drop of 10.1 days in the control states. Prior to the implementation of the state laws in 2016, days of opioids prescribed had aligned in both groups of states.

In addition, after the data were adjusted for state-level differences in race, urbanization, median income, tobacco use, alcohol use, serious mental illness, region and state-level fixed effects, the opioid prescription laws were linked to a reduction of 1.7 days for each enrollee (95% CI, –0.62 to –2.87 days). Although primary care physicians had the largest decrease in opioid prescribing, the change was not significantly different among the two groups of states. Conversely, there was a significant reduction in opioid prescribing between the states among surgeons and dentists (0.90-day decrease for each prescription; 95% CI, –1.37 to –0.42), pain specialists (0.45-day decrease; 95% CI, 0.73-0.17) and other specialists (0.29-day decrease; 95% CI, –0.5 to –0.09), according to Cramer and colleagues.
The results suggest “a significant but limited outcome for such legislation,” the researchers wrote, adding the laws were just one of many initiatives that sought to reduce opioid prescriptions.

In a related editor’s note, Deborah Grady, MD, MPH, associate dean of clinical and translational research at the University of California, San Francisco, and Mitchell H. Katz, MD, president and CEO of NYC Health + Hospitals, said laws that limit initial opioid prescriptions to 3 or 5 days may leave some patients’ pain untreated, or patients have to go to “extraordinary effort to obtain adequate pain relief.”

They added that the study indicates initial prescriptions of 7 days or fewer is helpful, “but we would not restrict any further given that we do not know how it affected patients with acute pain.”

References:

Cramer J, et al. JAMA Intern Med. 2021;doi:10.1001/jamainternmed.2021.4281.

Grady DG and Katz, MH. JAMA Intern Med. MH. doi:10.1001/jamainternmed.2021.4280.