A Look at State Legislation Limiting Opioid Prescriptions
ASTHO recently received a request for information about states adopting initial opioid prescription limits. Over the past year, nine states (Connecticut, Delaware, Maine, Massachusetts, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont) have added by statute or agency rule limits to the initial amount of opioids medical professionals may prescribe. The prescription limits are often set at a daily supply or are in morphine milligram equivalents (MMEs).
The limits generally apply to an initial opioid prescription for “acute pain” (i.e., pain resulting from disease, accidental, trauma, surgery, or another cause, that is reasonably expected to last only a short period of time). The laws often exclude initial prescriptions for certain conditions or patients such as chronic pain, pain associated with a cancer diagnosis or treatment, palliative care, hospice care, residents of long-term care or nursing facilities, and individuals receiving treatment for substance use disorders. Exemptions to the limits are also often allowed when the medical professional determines that the condition causing the acute pain requires more than the initial limited supply.
Several other states are considering initial opioid prescription limits in their 2017 legislative sessions. Bills limiting the amount of prescription opioids are pending in Georgia (HB400), Hawaii (HB667), Indiana (SB226), Kentucky (SB193), Montana (HB409), Oregon (HB2114), and Washington (HB1339).
Below is a graph setting out the states with existing or proposed initial prescription limits, the type of limit (e.g., daily, MMEs, or both), and the common conditions and patients exempted from the limits.
As with any other public health intervention, the laws limiting initial opioid prescriptions should be monitored and evaluated. So far, the newness of the limits makes it difficult to determine their impact on opioid misuse and addiction. However, research is emerging on the impact of other legal interventions such as prescription drug monitoring programs (PDMPs). One review of several laws enacted from 2006 to 2012 that were designed to reduce opioid misuse concluded there is no association between the legal interventions and a reduction in opioid misuse or overdose in disabled Medicare populations, however, two other studies have found that the implementation of a PDMP was associated with a reduction in opioid prescriptions and opioid-related deaths.The effects of opioid prescription restrictions established by private insurers are also coming to light. After Blue Cross Blue Shield of Massachusetts learned that many of its members were receiving initial opioid prescriptions of 30-days or more the company implemented a comprehensive opioid utilization program which included prescription supply limits. The analysis of the insurer’s policy changes revealed a reduction in opioid prescribing.
While it will take time to see the impact of the initial prescription limits on opioid use and addiction, we are already seeing proposed tweaks to the laws enacted last year. For example, a bill in New York bill (A 3528) would prohibit insurers from collecting a copay from patients who require a follow up appointment for an additional opioid prescription after an initial opioid prescription is written. ASTHO will continue to monitor state legislatures as the use of this novel intervention expands.
Disclaimer: The legal information provided above does not constitute legal advice or legal representation. For legal advice, please consult your legal counsel.
Andy Baker-White, JD, MPA, is senior director of state health policy at ASTHO.