Florida’s Restrictive Opioid Law HB21 Did Not Lead to Increased NSAID Prescriptions

Clinician filling out a prescription
Clinician filling out a prescription
The researchers evaluated how an opioid restriction law in Florida affected the use of prescription NSAIDs.

After the implementation of House Bill 21 (HB21) in Florida, which restricted opioid analgesic prescriptions to a maximum 3-day supply, prescriptions of nonsteroidal anti-inflammatory drugs (NSAIDs) did not increase, according to findings from a quality improvement study published in JAMA Network Open.

Data from a single health plan which served 45,000 employees in Florida were analyzed for pharmacy prescription claims for NSAIDs between 2015 and 2019. HB21 was implemented in July of 2018. Claims before HB21 (2015-2018) were compared with after HB21 (2018-2019) was implemented.

A total of 62,125 NSAID prescriptions were filled and picked up during the study period. After removing combinatorial NSAIDs and duplicate users, 42,624 individuals used oral NSAIDs and 5138 individuals used nonoral NSAIDs.

NSAID users had a median age of 47 (interquartile range [IQR], 35-57) years.

The oral NSAIDs included ibuprofen (33%), meloxicam (26%), naproxen (15%), and others (26%). The nonoral NSAIDs were diclofenac sodium (93%), diclofenac epolamine (3%), and others (4%).

After the bill was enacted, NSAID prescriptions increased by 1.49 (95% CI, -3.38 to 6.37) per 1000 enrollees. Prior to HB21, there was a nonsignificant decreasing trend for NSAID claims (rate change, -0.03; 95% CI, -0.13 to 0.07 per month per 1000 enrollees) and after the bill there was a nonsignificant increasing trend (rate of change, 0.15; 95% CI, -0.47 to 0.77 per month per 1000 enrollees).

Stratified by NSAID delivery method neither oral (rate of change, 0.33; 95% CI, -0.25 to 0.91 per month per 1000 enrollees) nor nonoral (rate of change, -0.13; 95% CI, -0.29 to 0.02 per month per 1000 enrollees) NSAID prescriptions increased after HB21 was implemented.

For users of NSAIDs, there was a significant decreasing trend before the law implementation (rate of change, -0.03; 95% CI, -0.06 to -0.01 per month per 1000 enrollees). After implementation, there was a nonsignificant increase in oral NSAID users (change, 1.12; 95% CI, -0.32 to 2.56 per month per 1000 enrollees) and a nonsignificant decrease in nonoral NSAID users (change, -0.26; 95% CI, -0.67 to 0.16 per month per 1000 enrollees).

This study was limited by not including data from over-the-counter NSAID purchases. It remains unclear whether the reduction in available opioids caused an increase in nonprescription NSAID use.

These data indicated that after the Florida law HB21, which restricted opioid prescriptions for analgesic use to 3-days, no increase was observed in NSAID prescription claims or NSAID users.


Keshwani S, Grande I, Maguire M, Goodin A, Vouri SM, Hincapie-Castillo JM. Trends in use of prescription nonsteroidal anti-inflammatory medications before vs after implementation of a Florida law restricting opioid prescribing for acute pain. JAMA Netw Open. 2021;4(6):e2113383. doi:10.1001/jamanetworkopen.2021.13383