• Ashley C Bradford, Thuy Nguyen, Lucy Schulson, Andrew Dick, Sumedha Gupta, Kosali Simon, and Bradley D Stein.
• School of Public Policy, Georgia Institute of Technology, Atlanta, GA, USA. bradford@gatech.edu.
• J Gen Intern Med. 2024 Nov 1; 39 (14): 268926972689-2697.

BackgroundHow state opioid policy environments with multiple concurrent policies affect opioid prescribing to individuals with acute pain is unknown.ObjectiveTo examine how prescription drug monitoring programs (PDMPs), pain management clinic regulations, initial prescription duration limits, and mandatory continued medical education affected total and high-dose prescribing.DesignA county-level multiple-policy difference-in-difference event study framework.SubjectsA total of 2,425,643 individuals in a large national commercial insurance deidentified claims database (aged 12-64 years) with acute pain diagnoses and opioid prescriptions from 2007 to 2019.Main MeasuresThe total number of acute pain opioid treatment episodes and number of episodes containing high-dose (> 90 morphine equivalent daily dosage (MEDD)) prescriptions.Key ResultsApproximately 7.5% of acute pain episodes were categorized as high-dose episodes. Prescription duration limits were associated with increases in the number of total episodes; no other policy was found to have a significant impact. Beginning five quarters after implementation, counties in states with pain management clinic regulations experienced a sustained 50% relative decline in the number of episodes containing > 90 MEDD prescriptions (95 CIs: (Q5: - 0.506, - 0.144; Q12: - 1.000, - 0.290)). Mandated continuing medical education regarding the treatment of pain was associated with a 50-75% relative increase in number of high-dose episodes following the first year-and-a-half of enactment (95 CIs: (Q7: 0.351, 0.869; Q12: 0.413, 1.107)). Initial prescription duration limits were associated with an initial relative reduction of 25% in high-dose prescribing, with the effect increasing over time (95 CI: (Q12: - 0.967, - 0.335). There was no evidence that PDMPs affected high-dose opioids dispensed to individuals with acute pain. Other high-risk prescribing indicators were explored as well; no consistent policy impacts were found.ConclusionsState opioid policies may have differential effects on high-dose opioid dispensing in individuals with acute pain. Policymakers should consider effectiveness of individual policies in the presence of other opioid policies to address the ongoing opioid crisis.© 2024. The Author(s), under exclusive licence to Society of General Internal Medicine.

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