Study: State Laws Intended to Reduce Opioid Prescribing had Little Impact on Prescribing Practices

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State laws intended to curb opioid prescribing practices had no effect on opioid prescribing patterns for commercially insured adults, including a subgroup with chronic noncancer pain conditions, according to a new study published in Annals of Internal Medicine.

“There is concern that state laws to curb opioid prescribing may adversely affect patients with chronic noncancer pain, but the laws' effects are unclear because of challenges in disentangling multiple laws implemented around the same time,” wrote authors led by Emma McGinty, PhD, MS, professor, Department of Health Policy and Management, co-director, Center for Mental Health and Addiction Policy Research, Johns Hopkins Bloomberg School of Public Health.

McGinty and colleagues analyzed 13 states that implemented 1 of the following laws in 2010 or later:

• Opioid prescribing cap laws (Delaware, Kentucky, New York, Ohio).
• Pill mill laws (Mississippi, Ohio, Texas).
• Mandatory prescription drug monitoring program query laws (New York, Oklahoma, Pennsylvania, Virginia).
• Mandatory prescription drug monitoring program enrollment laws (Colorado, Idaho).

The team compared patterns in opioid prescribing and guideline-concordant nonopioid pain treatment in the 2 years before and after the law was implemented to patterns in a group of control states over the same time. Augmented synthetic control analyses were used to estimate the association between each state law and outcomes, according to the study abstract.

Using insurance claims data from the large IBM Marketscan database, investigators examined 7 694 514 adults aged ≥18 years, of whom 1 976 355 were diagnosed with arthritis, low back pain, headache, fibromyalgia, and/or neuropathic pain.

McGinty et al measured the proportion of patients receiving any opioid prescription or guideline-concordant nonopioid pain treatment per month, and mean days' supply and morphine milligram equivalents (MME) of prescribed opioids per day, per patient, per month.

For adults overall and those with chronic noncancer pain, the 13 state laws were each associated with a change of less than 1 percentage point in the proportion of those who received any opioid prescription and a change of less than 2 percentage points in the proportion who received any nonopioid treatment, per month, according to the results.

The state laws were also associated with a change of less than 1 in days' supply of opioid prescriptions and a change of less than 4 in average monthly MME per day per patient prescribed opioids.

“While trends in the volume of prescriptions have been steadily declining over the last decade, our study suggests that those declines have not been driven by state opioid prescribing laws,” said McGinty in a Bloomberg School press release. “The findings suggest that the decline in opioid prescribing may be driven more by shifting clinical guidance, changing professional norms, or other factors.”

The study’s limitations included the fact that the results may not be generalizable to noncommercially insured populations and were vague for some estimates and use of claims data precluded assessment of the clinical appropriateness of pain treatments.