• Elizabeth C Danielson, Christopher A Harle, Ross Silverman, Justin Blackburn, and Nir Menachemi.
• Center for Education in Health Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
• Pain Med. 2021 Dec 11; 22 (12): 2941-2949.

ObjectiveIn 2016, the Center for Disease Control and Prevention released an opioid prescribing guideline for primary care in response to opioid overdose deaths. Despite efforts to encourage safer prescribing practices, experts and federal agencies suspect prescribing guidelines may be misapplied in clinical practice, resulting in abrupt tapering from opioid therapy. Although state laws likely influence prescriber behavior, little is known about state tapering laws. Thus, we examined the scope and variation of state tapering laws compared with federal opioid guidelines.MethodsWe conducted a comprehensive review of state laws through December 31, 2019, using keyword searches in LexisNexus. Identified laws were coded based on the inclusion of attributes derived from federal opioid guidelines and an expert consensus panel report. We examined whether law attributes were associated with state characteristics, including region, population, governor's political affiliation, opioid prescribing rates, and opioid overdose rates.ResultsWe found 27 states and one federal district had law(s) mentioning tapering. Most laws were authored by medical boards or workers' compensation groups (65.6%) while some laws included a penalty (32.8%). Approximately half of guideline attributes (54.2%) were included in state laws; however, only two state's laws cautioned against abrupt tapering. States with higher overdose death rates were more likely to enact a tapering law (P < 0.001) and have a penalty (P = 0.007).ConclusionsState tapering laws incorporate some federal guideline attributes but most lack attributes deemed critical by experts. Without clear instruction, patients risk inappropriate tapering and discontinuation of opioid therapy. Given these findings, policymakers should consider addressing this gap.© The Author(s) 2021. Published by Oxford University Press on behalf of the American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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