Association of State Opioid Prescription Duration Limits With Changes in Opioid Prescribing for Medicare Beneficiaries
Year: 2021
Type: article
Study design: Observational Study
Abstract: Between March 2016 and July 2018, 23 states implemented legislation limiting the duration of initial opioid prescriptions to a maximum of 7 days (17 states [74%] limited to 7 days or less, 2 [9%] to 5 days or less, and 4 [17%] to 3 days or less), 1 yet the effect of these policies on opioid prescribing remain poorly understood. 2 A previous analysis of Massachusetts and Connecticut found inconsistent results between states.3 As 43% of the US population lives in one of these 23 states, it is worthwhile to examine whether legislation limiting opioid prescription duration is associated with changes in prescribing.Methods | Using Medicare Part D Prescriber Public Use File between January 1, 2013, and December 31, 2018, we performed a controlled before-and-after cohort study using a difference-in-differences model with state-level fixed effects to assess the influence of laws limiting initial opioid prescriptions to a maximum of 7 days across all episodes of care.We excluded states that implemented selective policies (ie, where restrictions on opioid prescribing applied only to a subset of Medicare beneficiaries or to selected medical specialties, or where the state delegated authority to another entity).Our primary outcome was the mean number of days of opioids prescribed per Medicare Part D enrollee per year.States exposed to the policy were coded as a continuous variable between 0 and 1, adjusting for the proportion of the year that the law was in effect and including a 30-day washout period to allow for uptake.Our model adjusted for state-level differences in race, urbanization, median income, tobacco use, alcohol use, serious mental illness, region, and state-level fixed effects using data from the US census and the National Survey on Drug Use and Health.Statistical analysis was conducted with SPSS, version 26 (IBM).Data were analyzed from December 1, 2020, to April 1, 2021.This cohort study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.As an analysis of deidentified, publicly available data, this study was determined to be exempt from informed consent by the institutional review board of Wayne State University.
Source: JAMA Internal Medicine
Institutions: Wayne State University, University of Michigan, Michigan Medicine
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W3190411443