The Effect of State Legislation on Opioid Prescriptions Following Arthroscopic Rotator Cuff Repair

Abstract

New Jersey State Law, P.L. 2017 Chapter 28 22, C.24:21–15.2, passed in February 2017, is the most restrictive opioid legislation passed thus far in the United States. This study evaluated the effects of this legislation on the postoperative opioid prescriptions of patients undergoing arthroscopic rotator cuff repair (RCR). Opioid prescriptions were compared following arthroscopic RCR before and after implementation of the new law using the New Jersey Prescription Monitoring Program Aware Drug Database. A consecutive cohort of patients who underwent RCR during a 6-month period prior to the legislation was compared with a consecutive cohort of patients who underwent RCR during a 6-month period after the law went into effect. The primary outcome measure was prescribed postoperative milligram morphine equivalents (MME) and number of pills prescribed. There were 265 patients in the pre-law cohort and 198 patients in the post-law cohort. In the pre-law cohort, there was a median of 1250 MME (interquartile range [IQR], 900–1800 MME) and a median of 100 pills (IQR, 60–175 pills) prescribed postoperatively. In the post-law cohort, a median of 900 MME (IQR, 550–1050 MME) and a median of 60 pills (IQR, 60–90 pills) were prescribed postoperatively. A comparison of pre-law and post-law data for MME and number of pills prescribed was statistically significant ( P <.001). The median opioid consumption MME and number of pills prescribed following RCR decreased significantly following the implementation of the New Jersey state law. Findings of this study indicate state regulations may play a role in reducing narcotic consumption following RCR. [ Orthopedics . 2021;44(1):e80–e84.]

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

“…The results of this study are inconsistent with null findings from prior evaluations of the laws using general population samples, 4,5 but are broadly consistent with single-state evaluations that have concluded that prescribing cap laws have reduced the amount of opioids prescribed postsurgically. [11][12][13][14][15][16][17][18][19][20][21] The discrepancy in results may be because most laws are intended to govern prescriptions for acute pain like postsurgical pain, whereas general population samples include a mix of people being treated for acute and chronic pain.…”

“…The emerging literature on the effects of these laws on postsurgical opioid prescribing has suggested they have reduced the amount of opioids prescribed. [11][12][13][14][15][16][17][18][19][20][21] Most studies evaluated a single state's law using data from a single institution. No study has evaluated the overall effects of prescribing cap laws on postsurgical prescribing across all states that have implemented them.…”

“…The emerging literature on the effects of these laws on postsurgical opioid prescribing has suggested they have reduced the amount of opioids prescribed 11–21 . Most studies evaluated a single state's law using data from a single institution.…”

Dramatic Reduction in Opioid Prescribing for Common Outpatient Orthopaedic Lower Extremity Surgical Procedures at a Louisiana University-Based Safety-Net Hospital After Enactment of Opioid-Limiting State Legislation

“…In addition, the percentage of patients who received at least one new opioid prescription The sharp drop-off in opioid prescribing observed in 2018 is likely attributable to state legislation passed in 2017 which limited opioid prescribing for acute pain, required prescribers to check the state's PDMP database before prescribing opioids, and mandated continuing education regarding best practices for prescribing controlled substances. Although other studies have documented reductions in opioid prescribing after the enactment of state opioid-limiting legislation for common orthopaedic surgeries, 13,[23][24][25][26][27][28] the patient populations in these studies were fairly homogenous. By contrast, the patient population in this study included a high proportion of Black patients and individuals with Medicaid insurance, both risk factors for prolonged opioid use after surgery.…”

Impact of state legislation and institutional protocols on opioid prescribing practices following pediatric tonsillectomy

“…There were similar numbers of males (47%) and females (53%). The majority of patients number of doses by Periods 1, 2, 3 were 44(25, 70); 20(14,28); and 19(15,25), respectively. There is significant variability in the number of doses per prescription, particularly in Period 1, which is supported by SMD >0.1 between groups.…”