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Effects of Opioid Prescribing Cap Laws on Opioid and Other Pain Treatments Among Persons with Chronic Pain

Abstract

Background

Many states have adopted laws that limit the amount or duration of opioid prescriptions. These limits often focus on prescriptions for acute pain, but there may be unintended consequences for those diagnosed with chronic pain, including reduced opioid prescribing without substitution of appropriate non-opioid treatments.

Objective

To evaluate the effects of state opioid prescribing cap laws on opioid and non-opioid treatment among those diagnosed with chronic pain.

Design

We used a difference-in-differences approach that accounts for staggered policy adoption. Treated states included 32 states that implemented a prescribing cap law between 2017 and 2019.

Population

A total of 480,856 adults in the USA who were continuously enrolled in medical and pharmacy coverage from 2013 to 2019 and diagnosed with a chronic pain condition between 2013 and 2016.

Main Measures

Among individuals with chronic pain in each state: proportion with at least one opioid prescription and with prescriptions of a specific duration or dose, average number of opioid prescriptions, average opioid prescription duration and dose, proportion with at least one non-opioid chronic pain prescription, average number of such prescriptions, proportion with at least one chronic pain procedure, and average number of such procedures.

Key Results

State laws limiting opioid prescriptions were not associated with changes in opioid prescribing, non-opioid medication prescribing, or non-opioid chronic pain procedures among patients with chronic pain diagnoses.

Conclusions

These findings do not support an association between state opioid prescribing cap laws and changes in the treatment of chronic non-cancer pain.

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Funding

This study was funded by Arnold Ventures. EMS was supported by T32MH109436. IS was supported by T32MH122357. The funding sources had no role in study design, data collection, analyses, interpretation of the results, or drafting of the manuscript.

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Correspondence to Alexander D. McCourt JD, PhD.

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Conflict of Interest

Authors McCourt, Tormohlen, Schmid, Stone, Stuart, Davis, and McGinty report no conflicts of interest. Dr. Bicket reports past service as a consultant for Axial Healthcare and Alosa Health, both unrelated to the submitted work.

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McCourt, A.D., Tormohlen, K.N., Schmid, I. et al. Effects of Opioid Prescribing Cap Laws on Opioid and Other Pain Treatments Among Persons with Chronic Pain. J GEN INTERN MED (2022). https://doi.org/10.1007/s11606-022-07796-8

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KEY WORDS

  • chronic pain
  • opioids
  • prescribing laws
  • opioid policy