State Laws Reduced Number of Days Opioids Prescribed
/By Pat Anson, PNN Editor
State laws that limit initial opioid prescriptions to seven days or less have reduced the number of days that opioid medication is prescribed to Medicare patients for short-term acute pain, according to a new study.
Nearly two dozen states implemented laws limiting the initial supply of opioids after the CDC released its 2016 opioid prescribing guideline. Seventeen states limited prescriptions to 7 days, two states capped them at 5 days, and four states limited prescriptions to just 3 days.
“The state legislation on opioid prescribing primarily targets initial opioid prescriptions provided for acute pain, and we observed decreases that were most pronounced among surgeons and dentists,” wrote John Cramer, MD, an assistant professor at Wayne State School of Medicine and lead author of the study published in JAMA Internal Medicine.
Cramer and his colleagues found that state laws capping initial opioid prescriptions were associated with an average reduction of 1.7 days in supply for each Medicare patient. Prescribing also fell in states without such laws, although not as much. Despite the declines, the study concluded that “excess opioid prescribing” was still prevalent among all patient populations.
The caps on duration were imposed to reduce the initial exposure of patients to opioids, with the goal of reducing the potential for diversion, addiction and overdose. The researchers did not examine whether those goals were achieved or if patients were satisfied with their pain relief.
“Because this study used administrative data, we do not know how the patients did — was their pain adequately controlled, did they have adverse effects from the opioids, did they have trouble renewing a prescription, or continue to take opioids months later?” asked Deborah Grady, MD, and Mitchell Katz, MD, in a JAMA editorial.
Grady and Katz said it was reasonable to limit initial prescriptions to seven days, but they are concerned about imposing stricter limits on opioids.
“We worry that restricting initial prescriptions to shorter periods, such as 3 or 5 days, as occurred in 6 states in this study, may result in patients with acute pain going untreated or having to go to extraordinary effort to obtain adequate pain relief,” they wrote. “We think the data in this study suggest that limiting initial prescriptions to 7 or fewer days is helpful, but we would not restrict any further given that we do not know how it affected patients with acute pain.”
It’s not just states that have imposed limits. Some insurers and pharmacy chains have also adopted policies that put caps on first-time opioid prescriptions.
A federal bill that would have limited initial opioid prescriptions to just three days nationwide was amended earlier this year after complaints from patient advocates. The new version of the Comprehensive Addiction and Recovery Act (CARA) contains no limits on the number of days opioids can be prescribed. Congress has not acted on the bill yet.
