What Makes Up an Opioid Prescribing and Dispensing Law in the United States?

A review of state laws found that opioid prescribing and dispensing policies are made up of 3 dimensions and likely cause heterogeneous effects across jurisdictions, according to the results of a study published in Pain Medicine.

Investigators from the RAND Corporation randomly selected 17 jurisdictions in the United States in which to evaluate important structural features of laws related with opioid prescribing and dispensation in those jurisdictions.

Laws about opioid prescribing and dispensing have 2 dimensions: the rule that must be followed and who the rule applies to. Some laws have an additional third dimension, which comprises the actions to be taken if the law is violated.

The first dimension addresses clinic licensure, staff credentials, evaluation of appropriateness of treatment, limiting opioid use, preventing misuse or diversion, and enhancing safety.

The second dimension comprises the applicability of the rule defining the setting, the practitioner, the medication type, the etiology of the pain, the prescribing situation, and the payer type.

The optional third dimension included disciplinary policies, inspections, and grievance filings.

Study authors stated that the effect on health services or patient outcomes of multiple components of these laws — such as formulation rules, patient identification requirements, mandatory assessment of substance use disorder, educational requirements for prescribers, mandatory consultations, and circumstances for mandatory opioid discontinuation — have not been sufficiently evaluated in clinical trials.

The nuances of these laws in each state likely have highly heterogenous effects on patient populations. For example, a prescription limit may only apply to specific practitioners in specific settings for certain types of pain and only for individuals with a particular kind of insurance.

A major limitation of this study is that laws in only 17 jurisdictions were reviewed. However, this study was designed to be a proof-of-concept and preliminary analysis as part of a larger, more comprehensive project.

Study authors concluded, “Through a systematic and comprehensive data collection process, we identified 3 dimensions of opioid prescribing/dispensing laws: the rule, its applicability, and its disciplinary consequences. Within each dimension, we created several policy categories. By highlighting the multi-dimensional nature of state opioid analgesic-related laws, our results suggest the need for a more comprehensive compilation of policy constructs and variables for legal epidemiological analysis.”