OBJECTIVES: We aimed to assess the impact of opioid prescription restriction laws for acute pain implementing limits on 3 days’ supply in Florida and Tennessee, 7 days’ supply in Colorado and South Carolina, and 10 days’ supply in Mississippi on the total Schedule-II opioid prescriptions dispensed in Medicaid programs.

METHODS: We analyzed aggregated schedule II opioid prescription data from the Medicaid State Drug Utilization Database from Jan/2016 to Apr/2020. We summed the number of prescriptions for each study quarter and divided over the total Medicaid enrollment to obtain quarterly prescription prevalence. We used interrupted time series models accounting for autocorrelation to determine any immediate change after the policy implementation and to estimate trends before and after the policy.

RESULTS: Similar to declining national trends, all states showed a significant decrease of opioid utilization over the entire study period (range of -3.1 to -7.9 prescriptions per 1,000 enrollees). After the implementation of restriction laws in Mississippi and Florida, there were no significant changes in level or trends in the prevalence of opioid utilization. In Colorado and Tennessee, after restriction laws were implemented in May and July 2018, respectively, there were significant increases in the trend of prescriptions dispensed, ameliorating the rapid decline in the pre-policy period. In Tennessee, there was a significant immediate decrease of 18.9 prescriptions dispensed per 1,000 Medicaid enrollees (95%CI -35.6, -2.2 per 1,000 enrollees). After the law implementation in South Carolina in May/2018, there was a significant immediate decrease of 9.5 prescriptions dispensed per 1,0000 Medicaid enrollees (95%CI -16, -2.9 per 1,000 enrollees).

CONCLUSIONS: There was an overall decline in opioid use among Medicaid enrollees from 2016-2020. Opioid restriction laws seem to have a stronger effect when they have stricter requirements on day’s supply. Further research analyzing claims data is needed to stratify patient populations by indication.