On March 15, 2022, a study led by researchers at Johns Hopkins Bloomberg School of Public Health was published in the Annals of Internal Medicine that found that state laws that are designed to curb opioid prescribing practices actually had no effect on opioid prescribing patterns for commercially insured adults overall, or for people with chronic, non-cancer pain.
In conducting the study, researchers reviewed thirteen treatment states that implemented one of the following laws in place in 2010 or beyond: opioid prescribing cap laws (limiting the dose and/or duration of an opioid prescription), pill mill laws (regulating pain management clinics), mandatory prescription drug monitoring program query laws (requiring prescribers to check the opioid prescription database before prescribing an opioid), and mandatory prescription drug monitoring enrollment laws (requiring prescribers enroll in a statewide electronic database that monitors opioid and other prescriptions).
Unique groups of control states for each treatment state were identified. Then, researchers compared patterns in opioid prescribing and non-opioid pain treatments in the thirteen identified states in the two years before and the two years after the law was implemented over the same period to estimate the association between each state law and the outcomes.
Specifically, the states examined were Delaware, Kentucky, New York, Ohio, Mississippi, Texas, Oklahoma, Pennsylvania, Virginia, Colorado, and Idaho. Each state implemented at least one of the four types of laws, with two states implementing two types. New York and Ohio counted for two state laws each, New York implemented opioid prescribing cap and mandatory prescription drug monitoring query laws while Ohio had opioid prescribing cap laws and pill mill laws.
The study encompassed 7,694,514 commercially insured adults, including 1,976,355 that were diagnosed with arthritis, low back pain, headache, fibromyalgia, and/or neuropathic pain.
As noted above, the study found that “laws were associated with small-in-magnitude and non-statistically significant changes in outcomes,” though the confidence intervals around some of the estimates were wide. For adults overall (and those with chronic non-cancer pain), the thirteen state laws were each associated with “a change of less than 1 percentage point in the proportion of patients receiving any opioid prescription and a change of less than 2 percentage points in the proportion receiving any guideline-concordant nonopioid treatment, per month.” The laws were also associated with a change of less than one days’ supply of opioid prescriptions and a change of less than four in average monthly morphine milligram equivalents (MME) per day per patient prescribed opioids.
The researchers did note that the study does have some limitations, including that the results may not be similar, or generalizable, to non-commercially insured populations and that the data were imprecise for some estimates. The researchers also noted that the use of claims data precluded assessment of the clinical appropriateness of pain treatments.
Beth McGinty, PhD, MS, professor in the Department of Health Policy and Management and co-director of the Center for Mental Health and Addiction Policy Research at the Bloomberg School, stated that “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.” Instead, she went on to say, “the findings suggest that the decline in opioid prescribing may be driven more by shifting clinical guidance, changing professional norms, or other factors.”