State Opioid Prescribing Limits Did Not Reduce Duration of Opioid Prescribing by Dentists

Implementation of state opioid prescribing limits did not appear to affect the duration of opioid prescriptions distributed by dentists, according to results of a study published in JAMA Network Open.

According to the study authors, “[A]t least 39 states have enacted restrictions on the duration of opioid prescriptions for patients with acute pain, patients who are new to opioids, or both.”

Data for this study were sourced from the national all-payer prescription database IQVIA and the Prescription Drug Abuse Policy System (PDAPS) database. Using a difference-in-differences cross-sectional study design, the investigators evaluated the duration of opioid prescriptions distributed by dentists by state. Duration of prescription was defined as days’ supply. Data were stratified into intervention states (which implemented prescribing limits between 2016 and 2018) and control states (which did not implement prescribing limits during that time period).

In the 22 states with prescribing limits included in the adult analysis, the maximum duration of opioid supply ranged from 3 days in Kentucky and West Virginia to 10 days in Mississippi. For children, prescribing limits ranged from a 3-day opioid supply in Vermont and West Virginia to a 10-day supply in Mississippi. However, 11 and 13 states allowed dentists to exceed limits based on professional discretion for adults and children, respectively.

A total of 56,607,314 prescriptions for adults and 3,720,837 prescriptions for children were included in this analysis. In both the adult and children groups, respectively, most prescriptions were distributed in states with prescribing limits (68.2% and 69.7%), were written for  women or girls (54.8% and 55.5%), and for the dispensing of hydrocodone (66.7% and 59.2%).

Among adults, the average duration of opioid prescription was 3.4 days. The monthly mean days’ supply decreased from 3.4 to 3.0 days in the states with prescribing limits compared with a decrease from 3.6 to 3.3 days in the states without prescribing limits; these results did not differ significantly (differential change in mean days’ supply, -0.06; 95% CI, -0.11 to <0.001 days). In states with prescribing limits, no significant differences were observed on the basis of limit restrictiveness or the prescribing dentist’s specialty.

For children, the average duration of opioid prescriptions was 3.6 days. The monthly mean days decreased from 3.6 to 2.9 days in states with prescribing limits and from 3.9 to 3.2 days in states without prescribing limits (differential change in mean days’ supply, -0.07; 95% CI, -0.15 to 0.02 days). As with adults, the specific state restrictiveness and the prescribing dentist’s specialty did not have a significant effect on duration of opioid prescribing among children.

Results were similar in sensitivity analyses that varied the duration of the limit anticipation period.

This study may have been biased by excluding states that implemented prescribing limits in 2019.

Study authors conclude, “State opioid prescribing limits were not associated with changes in the duration of dental opioid prescriptions from dentists for either adults or children. Future research is needed to investigate whether other interventions play a role in reducing dental opioid prescribing.”

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