• Katie Fitzgerald Jones, Lindsay Bell Abdulhay, Steve R Orris, Jessica S Merlin, Yael Schenker, and Hailey W Bulls.
• William F. Connell School of Nursing (K.F.J.), Boston College, Chestnut Hill, Massachusetts, USA. Electronic address: Jonesafq@bc.edu.
• J Pain Symptom Manage. 2022 Aug 1; 64 (2): 899989-99.

ContextOpioids are commonly used to relieve symptoms such as pain and dyspnea in people living with serious illness. In recent years, 36 states enacted limitations for opioid prescriptions to mitigate the impact of the opioid overdose crisis. Palliative care clinicians have been vocal about the unintended consequences of opioid policies, yet little is known about how state policies apply to opioid prescribing in non-cancer-related serious illness.ObjectiveTo summarize current state-level limitations to opioid prescribing and exemptions relevant to people living with non-cancer-related serious illness.MethodsInvestigators searched publicly available laws ("[state] + opioid legislation") to extract information on opioid prescribing and exemptions. Laws were examined for application to palliative care, hospice, non-cancer-related serious illness, and language about specific symptoms was documented when applicable (e.g., pain, dyspnea).ResultsMost state laws focused on acute pain and/or initial opioid prescriptions. Thirty-three of the thirty-six states with opioid-limiting legislation exempt situations applicable to people living with non-cancer-related serious illness. Three states did not have any exemptions relevant to people living with non-cancer-related serious illness.DiscussionThe results indicate that while most states recognize the importance of timely opioid access for palliation of pain, clinically relevant exemptions for people living with non-cancer-related serious illness may be lacking. When present, language describing palliative care, hospice, and terminal illness exemptions is often broad and may generate confusion between primary and specialty palliative care.Published by Elsevier Inc.

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