Effects of state opioid prescribing cap laws on opioid prescribing after surgery

Abstract

Objective To evaluate the effects of state opioid prescribing cap laws on opioid prescribing after surgery. Data Sources OptumLabs Data Warehouse administrative claims data covering all 50 states from July 2012 through June 2019. Study Design We included individuals from 20 states that had implemented prescribing cap laws without exemptions for postsurgical pain by June 2019 and individuals from 16 control states plus the District of Columbia. We used a difference‐in‐differences approach accounting for differential timing in law implementation across states to estimate the effects of state prescribing cap laws on postsurgical prescribing of opioids. Outcome measures included filling an opioid prescription within 30 days after surgery; filling opioid prescriptions of specific doses or durations; and the number, days' supply, daily dose, and pill quantity of opioid prescriptions. To assess the validity of the parallel counterfactual trends assumption, we examined differences in outcome trends between law‐implementing and control states in the years preceding law implementation using an equivalence testing framework. Data Collection/Extraction Methods We included the first surgery in the study period for opioid‐naïve individuals undergoing one of eight common surgical procedures. Principal Findings State prescribing cap laws were associated with 0.109 lower days' supply of postsurgical opioids on the log scale (95% Confidence Interval [CI]: −0.139, −0.080) but were not associated with the number (Average treatment effect on the treated [ATT]: −0.011; 95% CI: −0.043, 0.021) or daily dose of postsurgical opioid prescriptions (ATT: −0.013; 95% CI: −0.030, 0.005). The negative association observed between prescribing cap laws and the probability of filling a postsurgical opioid prescription (ATT: −0.041; 95% CI: −0.054, −0.028) was likely spurious, given differences between law‐implementing and control states in the pre‐law period. Conclusions Prescribing cap laws appear to have minimal effects on postsurgical opioid prescribing.

Prolonged Opioid Use and Pain Outcome and Associated Factors after Surgery under General Anesthesia: A Prospective Cohort Association Multicenter Study

“…There is a wide variation of postsurgical opioid prescribing patterns between individual prescribers 67 ; however, both single-institution reports ( e.g. , Nobel et al 68 ) and reports about national trends 69 indicate that postsurgical opioid prescribing is changing over time. With that, another limitation of this report is the age of the data, which were collected toward the end of 2017.…”

“…Relying on a convenience sample (e.g., no night or weekend cases, availability of study recruitment staff, some institutions focusing their enrollment on certain hospitals within their network) might have introduced bias and did not ensure that recruitment was representative of the general population. There is a wide variation of postsurgical opioid prescribing patterns between individual prescribers 67 ; however, both single-institution reports (e.g., Nobel et al 68 ) and reports about national trends 69 indicate that postsurgical opioid prescribing is changing over time. With that, another limitation of this report is the age of the data, which were collected toward the end of 2017.…”

Association Between State Opioid Prescribing Limits and Duration of Opioid Prescriptions From Dentists

“…These findings are consistent with those of a growing body of studies suggesting that state limits have done little to curb excessive opioid prescribing for acute pain. 8,10,20,21 There may be at least 2 reasons for the lack of association between implementation of limits and the duration of dental opioid prescriptions. First, approximately half of the treatment states in the adult and child analyses allowed dentists to exceed the limit based on their professional judgment.…”

“…Implementation of state opioid prescribing limits, most of which allowed up to a 7-day supply of opioids, was not associated with changes in the duration of these prescriptions. These findings are consistent with those of a growing body of studies suggesting that state limits have done little to curb excessive opioid prescribing for acute pain …”

Tapentadol and the opioid epidemic: a simple solution or short‐lived sensation?

“…Following the publication of the Centers for Disease Control and Prevention Guideline for Prescribing Opioids for Chronic Pain in 2016 [5], nearly every state in the USA within 2 years had codified laws restricting the prescription of opioid analgesics based on dosage or days of therapy [6]. Most of these laws were broad and applied to acute pain indications including pain after surgery, despite the guideline specifically identifying post‐surgical pain as “ outside the scope ” of the guideline, though it appears state laws had little impact on prescribing behaviour after surgery [7]. In the UK, the Medicines and Healthcare products Regulatory Agency issued a drug safety update warning of the risk of dependence and addiction related to opioids and providing recommendations to prescribing clinicians [8].…”