OBJECTIVES:

Many states have implemented limitations on opioid prescriptions for patients with acute pain. Few studies have investigated relationships between prescribing restrictions and clinical outcomes. We assessed effects of acute pain prescribing restriction laws on trends in opioid-related overdose deaths among states that implemented these policies.

METHODS:

We evaluated the effects of state laws on three outcomes: all-opioid, prescription opioid, and heroin-related overdose deaths. We ascertained overdose death counts using corresponding ICD-10 codes from the Centers for Disease Control and Prevention’s Wide-ranging OnLine Data for Epidemiologic Research database. We included states if they: 1) had complete and unsuppressed data for any outcome during all months between 2013 and 2018, 2) had implemented an acute pain prescribing restriction law between 2014-2017. We fitted interrupted time series models with control and accounting for autocorrelation. Controls were generated using combined data from six states that had complete and unsuppressed data for all outcomes and had not implemented acute pain prescribing restriction laws during the period of 2013-2017.

RESULTS:

For the all-opioid, prescription opioid, and heroin outcomes, thirteen, nine, and seven states met inclusion criteria for analysis, respectively. Twelve states showed a decreased trend in all-opioid overdose deaths during the post-law period relative to the counterfactual, six being statistically significant (decreases ranging from 0.17 to 0.85 deaths per 1,000,000 per month; p<0.05). Seven states decreased in trend in prescription opioid overdose deaths in the post-period relative to the counterfactual, one being statistically significant (decrease by 0.213 deaths per 1,000,000 per month; p<0.05). Six states decreased in trend in heroin overdose deaths in the post-period relative to the counterfactual, four being statistically significant (decreases ranging from 0.075 to 0.277 deaths per 1,000,000 per month; p<0.05).

CONCLUSIONS:

Acute pain opioid prescription restriction laws were associated with reduced opioid-related overdose deaths in six of thirteen states analyzed.