OBJECTIVES : High doses of opioids—90+ morphine milligram equivalent (MME)—pose serious risks of opioid overdose. Electronic prescribing (eRx) systems can use automated processes to monitor and flag high doses of opioids. In 2017, Maine mandated that prescriptions for controlled substances be submitted via eRx and enforced limits on the morphine milligram equivalents (MME) per day associated with opioid medication prescriptions. This study evaluates the impact of Maine’s eRx mandate on the number of opioid patients with high doses compared to patients from Arizona—a state that, like Maine, instituted similar limits on MME per day for opioid medication prescriptions, but did not mandate that controlled substances be submitted via eRx.

METHODS : Walgreens pharmacy claims data for patients using opioids in Maine (n=47,039) and Arizona (n=2,521,576) between January 2015 and July 2018 were used to calculate the percent of opioid patients with high doses in six month increments. With the exception of the eRx mandate, Maine and Arizona had similar requirements in prescribing and dispensing controlled substances. The data were analyzed using a differences-in-differences regression model.

RESULTS : Despite having implemented similar limits on the total per-day MME in opioid prescriptions, Maine’s eRx mandate was associated with a 17% reduction in the number of opioid patients with high doses over every 6-months compared to Arizona (p < 0.001). There were no significant differences in the outcome variable between test and control patients before the mandate.

CONCLUSIONS : The significant decline in high-dose opioid prescriptions in Maine compared to Arizona is plausibly attributable to the 2017 eRx mandate. If Arizona mandated eRx for controlled substances, approximately 2,800 fewer Walgreens patients would fill prescriptions per year for high dose opioids. ERx mandates reduce the prevalence of opioid patients with high doses potentially saving lives.