Do Legal Limits on Opioid Prescriptions Affect Prescribing Practices?

A change in legislation had significant effects on opioid prescribing behaviors in North Carolina, according to a study published in Pain Medicine.

The Strengthen Opioid Misuse Prevention (STOP) Act was implemented in 2018 in North Carolina with the purpose of decreasing opioid supply in the community and preventing patients from “shopping” for a physician who would prescribe opioids. One of the provisions in the legislation was to limit opioid prescribing for acute pain to a 5-day supply.

Researchers sought to evaluate how the STOP Act affected opioid prescribing practices for patients with acute or post-surgical musculoskeletal pain, using data from a large health care system in North Carolina. Prescribing practices from 2016 though January 1, 2018 (pre-STOP), were compared with practices after that date through 2020 (post-STOP).

During the study entire period, a total of 14,770 opioid prescriptions were distributed.

Pre-STOP, the rates of prescribing a 7-day supply or less were increasing by 1.1% monthly (b, 0.011; P <.0001). When controlling for the pre-implementation trend, post-STOP prescribing rates for a short opioid supply increased significantly by 17.7% (b, 0.177; P =.0002). The pre- and post-STOP trends differed significantly (b, -0.005; P =.0440).

The likelihood of being prescribed a prescription with 7 or fewer days’ supply increased significantly after the passage of the STOP Act (adjusted odds ratio [aOR], 6.6; 95% CI, 6.06-7.18).

The investigators noted that opioid prescribing practices began to change after the STOP Act was signed into law but before it was enforced. However, the trends were less pronounced compared with after its rollout.

These trends may have been limited by relying on diagnosis coding to identify patients with acute musculoskeletal pain, as some patients who had chronic pain and an acute injury may have been captured.

These data suggested that legislation can significantly affect opioid prescribing practices. The study authors concluded, “The results of this study can also be used to guide future legislation. Signing the STOP Act into law changed prescriber behavior significantly without additional surveillance or enforcement, even before the legislation officially went into effect.”

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.