One response to the opioid crisis and the high rates of opioid use disorder (OUD) throughout the country has been the creation of state policies that place restrictions on opioid prescriptions. These policies limit the duration and dosage of short-term opioid prescriptions for acute pain by aiming to reduce the transitions from short-term to chronic opioid use, reduce the stock of unused drugs that may make their way to users without prescriptions, and prevent unintentional addiction. However, evidence for the association of these policies with regard to changes in prescribing practices, patient outcomes, and effects on the overall crisis is mixed.
Many states enacted prescribing laws following the publication of the 2016 CDC Clinical Practice Guidelines for Prescribing Opioids, recommending that the duration and dosage of opioids be reduced whenever possible. These guidelines were based on the rationale and evidence that many prescribed opioids are never taken, people who misuse opioids often obtain them from a healthcare provider, and the demonstrated associations between exposure to opioids and the risk of long-term use. Similar policies have also been enacted by private organizations including retail pharmacies and insurance companies.
Researchers and advocates have highlighted the limitations of the evidence on which these policies were based and the potential unintended consequences of such policies, including chronic pain patients turning to more harmful substances or behaviors to compensate for reduced access to prescription opioids. Limits can also make it more difficult for chronic pain patients to receive treatment, promote the use of imprecise and potentially stigmatizing language, and may harm patients abruptly cut off from opioids. Another key criticism has been that the rigid limits downplay the individual nuances of pain management and the variety of factors that prescribers should take into consideration. After ongoing debate and additional research in the field, the CDC guidelines have since been revised to promote more flexible and patient-centered care.
In 2017, NJ passed its law with bipartisan support that limits new opioid prescriptions for acute pain to a 5-day supply of the lowest effective dose but is not applicable to patients receiving opioids for cancer treatment or palliative or end-of-life care. The law also requires that providers discuss benefits, risks, and alternatives to opioid treatment with their patients.
A study published earlier this year by the Rutgers Institute for Health, Healthcare Policy, and Aging Research gives some insight into the impact of NJ’s policy. The study used an interrupted time series analysis, a quasi-experimental method often used to evaluate policies and large-scale interventions and compared prescribing trends before and after the implementation of the policy in 2017. It specifically assessed prescribing patterns and patient outcomes among Medicaid beneficiaries from 2014 to 2019 using Medicaid claims data.
The authors found that implementation of the policy was associated with a smaller proportion of new prescriptions with a greater than 5-day supply, but it was not associated with a decline in overall new opioid prescriptions. They found no overall reduction in transitions to long-term use. These findings were similar to the results of similar studies from other states, suggesting that these policies have had minimal impact so far.
This study highlights that there is a need for further understanding of the long-term effects of these prescribing limits, and continued research to inform policies aimed at combatting the opioid crisis. Complementary strategies focusing on harm reduction, treatment for OUD, and addressing contributing socioeconomic factors remain critical paths forward in improving the crisis and opioid-related outcomes.