Study of non-cancer pain patient data finds state opioid prescription laws don’t influence prescribing practices

A new study led by researchers at Johns Hopkins Bloomberg School of Public Health found that state laws designed to curb opioid prescribing practices had no effect on opioid prescribing patterns for commercially insured adults overall or for people with chronic, non-cancer pain.

The study, published online March 15 in the Annals of Internal Medicine, addresses the concern that state laws aimed at addressing prescription opioid misuse might lead to some chronic pain patients missing out on critical pain treatment.

The U.S. opioid overdose crisis was initially driven by the overprescribing of pain medication nationwide. Since 2010, states have passed multiple laws designed to reduce opioid prescribing, including laws that limit the dose and duration of an opioid prescription and laws that regulate opioid dispensing by pain management clinics. Pain experts and patient advocates have expressed concern that these laws may negatively affect people with chronic pain by restricting access to opioid treatment without substituting effective non-opioid alternatives.

“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,” says 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. “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 looked at 13 states that put one of the following laws in place in 2010 or later:

• opioid prescribing cap laws, which limit the dose and/or duration of an opioid prescription
• pill mill laws, which regulate pain management clinics
• mandatory prescription drug monitoring program query laws, requiring a prescriber to check the opioid prescription database to review prescribing history before prescribing an opioid
• mandatory prescription drug monitoring program enrollment laws, which require prescriber enrollment in a statewide electronic database that monitors opioid and other prescriptions

For the study, the researchers compared patterns in opioid prescribing and non-opioid pain treatments in these 13 states in the two years before and after the law was implemented to patterns in a group of control states over the same period.

The state laws studied broke down into the following categories: four states with opioid prescribing cap laws (Delaware, Kentucky, New York, Ohio); three with pill mill laws (Mississippi, Ohio, Texas); four with mandatory prescription drug monitoring query laws (New York, Oklahoma, Pennsylvania, and Virginia); and two with mandatory prescription drug monitoring enrollment laws (Colorado and Idaho).

For their analysis, the researchers used insurance claims data from the IBM Marketscan database—a national commercial insurance claims database that includes inpatient, outpatient, and pharmacy claims for 350 insurers. The study sample included 7,694,514 adults. Of these, 1,976,355 adults were diagnosed with non-cancer conditions that often lead to chronic pain—arthritis, low back pain, headaches, fibromyalgia, and/or neuropathic pain.

After analyzing the insurance claims from both groups, the researchers found that state laws were associated with a less than one percent change in the proportion of patients receiving an opioid prescription. The state laws examined in the study were also associated with a less than two percent change in the proportion of patients receiving a non-opioid pain treatment.

In addition to no changes in prescribing patterns, the study also found that among those who received an opioid prescription, state laws were not associated with any significant changes in the days’ supply of the prescription (less than one day’s difference) nor with any significant changes in opioid dosage practices.

# # #

“Effects of state opioid prescribing laws on use of opioid and other pain treatments among commercially insured U.S. adults” was written by Beth McGinty, Mark Bicket, Nicholas Seewald, Elizabeth Stuart, Caleb Alexander, Colleen Barry, Alexander McCourt, and Lainie Rutkow.

The study was supported by the National Institute on Drug Abuse (R01DA044987).