State Opioid Prescribing Limits Are Not Associated With Reduced Prescribing or Overdose

The rise in opioid prescribing and overdose that began in the US in the 1990s has led to a number of interventions to discourage and limit opioid prescribing, including state laws that “cap” or limit dose and/or duration of initial opioid prescriptions. This study used 2013–19 administrative insurance claims from commercial and Medicare Advantage plans to investigate the association between state cap laws and opioid prescribing and overdose.

• Between 2017 and 2019, 32 states implemented a cap law; 16 states (plus the District of Columbia) did not. Two states that implemented laws before 2017 were not included. The characteristics of the 2 cohorts prior to implementation, including opioid prescribing and overdose rates, were similar.
• State opioid cap laws were not associated with any of the opioid prescribing outcomes, including proportion of persons receiving a prescription and the volume, duration, or dosage of the prescriptions.
• State opioid cap laws were not associated with opioid overdose outcomes overall, or with prescription or non-medical opioid overdose rates.

Comments: This study suggests that state cap laws do not have a significant impact on opioid prescribing or overdose. This is probably because these laws were implemented in the context of growing awareness of harms, and implementation of other measures and efforts to limit prescribing. While well-intended, these laws create additional administrative burdens for clinicians and pharmacies without proven value.

Darius A. Rastegar, MD

Reference: Tormohlen KN, McCourt AD, Schmid I, et al. State prescribing cap laws’ association with opioid analgesic prescribing and opioid overdose. Drug Alcohol Depend. 2022;240:109626.