Assessing the Impact of Opioid Prescription Duration Limits

Contact PD/PI: Allen, Lindsay PROJECT ABSTRACT West Virginia (WV) is one of 22 states that have implemented prescription duration limits to combat the national opioid epidemic. In June 2018, WV implemented the Opioid Reduction Act (ORA), which made it illegal for providers to prescribe more than seven days’ worth of opioids to most patients. The intention of this policy is to minimize patient exposure to opioids, thereby reducing dependence rates, overdoses, and costly health care utilization. However, limiting prescription supply may have unintended adverse consequences, including increased health care use or suicide due to uncontrolled pain, and use of illicit non-prescription substances (e.g., heroin, illegally manufactured fentanyl) as a substitute for legally-prescribed opioids. Despite these competing potential impacts, no study has assessed the impact of a prescription duration limit policy. The proposed study will be the first to measure the impact of the ORA on prescription patterns (Aim 1), health care use (Aim 2), and health outcomes (Aim 3). Crucially, we will assess both intended and unintended – yet potentially dire – impacts of the policy. We will address this important knowledge gap by using an innovative “dose response” event-study methodology. In particular, we will compare outcomes in areas (counties) more “exposed” to the ORA to those in less exposed areas. We define relative exposure as the rate of opioid prescriptions that exceeded the policy’s limit on days’ supply, prior to the ORA’s implementation. This approach has an important advantage over other methods: we are able to distinguish between metrics that will be disproportionately targeted by ORA (which is based specifically on days’ supply) versus other opioid-specific metrics (e.g., number of prescriptions), which are likely to be influenced by other opioid reduction policies. This allows us to isolate the impact of ORA alone, unlike other methodological approaches, which may be biased due to the many other opioid-related policies that have been implemented. Data for the study come from Medicaid claims that we will link to WV vital statistics death records, which are among the most detailed in the United States. Results from this study will provide urgently-needed evidence that will inform public health policy and clinical practice across the US. One benefit of using WV is that our results will be particularly relevant to the broader Appalachian population, a group that has been especially ravaged by the opioid crisis. This study is firmly aligned with NIDA's research emphasis on provider and health systems-based approaches to drug abuse prevention. Page 6 Project Summary/Abstract