State Legal Restrictions on Opioids Ineffective

State Legal Restrictions and Prescription-Opioid Use among Disabled Adults — NEJM

In response to rising rates of opioid abuse and overdose, U.S. states enacted laws to restrict the prescribing and dispensing of controlled substances.

The effect of these laws on opioid use is unclear.

Despite the exhortations to use only evidence-based methods, it’s a remarkable oversight that the effects of all these restrictions has never been studied.

I suspect PROP is trying their best to avoid this because they know the results won’t bear out their biased and prejudiced predictions.  

From 2006 through 2012, states added 81 controlled-substance laws.

Conclusions

Adoption of controlled-substance laws was not associated with reductions in potentially hazardous use of opioids or overdose among disabled Medicare beneficiaries, a population particularly at risk. (Funded by the National Institute on Aging and others.)

legislative restrictions showed no measurable association with the percentage of beneficiaries filling prescriptions that yield high daily opioid doses or the percentage treated for nonfatal prescription-opioid overdose.

Laws that restrict the prescribing and dispensing of controlled substances showed few meaningful associations with the receipt of prescription opioids by disabled Medicare beneficiaries in our sample

There was little systematic association between individual types of controlled-substance laws and each of the opioid-related outcomes (Figure 3Figure 3

Estimated Difference in Opioid Measures Associated with Individual Types of Controlled-Substance Laws

For example, none of the four opioid-prescribing outcomes had significant associations with the two types of laws that were most broadly adopted during this period, PDMPs and requirements related to tamper-resistant prescription forms.

In comparisons between years with operational PDMPs and those without them, the percentage of beneficiaries with four or more opioid prescribers declined little (−0.14 percentage points; 95% confidence interval [CI], −0.42 to 0.14), and the percentage of beneficiaries with a daily MED of more than 120 mg did not decline (0.27 percentage points; 95% CI, −0.05 to 0.59).

Statistical Analysis

We measured state controlled-substance laws according to whether each of eight types of laws was operating throughout the year in that state; according to legislative intensity, the number of types of laws added since baseline (2006) in each year and state, coded as indicators (1, 2, or ≥3 types of laws added; 0 is the reference) to allow for nonlinear effects; and according to the number of types of laws (as a single continuous variable) in place in a given state and year (range, 0 to 8).

State Laws

We measured nonfatal prescription-opioid overdose on the basis of primary or secondary diagnosis codes in emergency department and inpatient claims, excluding heroin overdose

Using Medicare claims, we created annual measures indicating

whether a beneficiary filled an opioid analgesic prescription in every calendar quarter in a given year (long-term receipt) or in one to three calendar quarters (non–long-term receipt),

filled prescriptions from four or more prescribers, and

filled prescriptions that resulted in a daily morphine-equivalent dose (MED) of more than 120 mg in any calendar quarter

Outcomes — Filling of Opioid Prescriptions and Nonfatal Overdose Events

Cohorts included beneficiaries 21 to 64 years of age, from 50 U.S. states and the District of Columbia, who were enrolled in fee-for-service Medicare Parts A, B, and D

For each calendar year 2006 through 2012, we created cohorts from a random 40% sample of all Medicare beneficiaries

Methods Study Population

To understand the relationship between state controlled-substance restrictions and the behaviors that they target, we examined associations between prescription-opioid outcomes and eight types of controlled-substance restrictions over a period of 7 years in a large national sample of patients.

Our population consisted of disabled Medicare beneficiaries younger than 65 years of age, half of whom use opioids in a given year.2

Successful regulation of prescription opioids involves a difficult balance.

They talk about balance, but their approach is utterly without it. All legislation is only about restricting opioids and none regard opioid medication as essential for some people.

Well-designed laws may reduce misuse and overdose. However, laws may also obstruct compassionate pain management and increase provider burden.7 Moreover, heavily promoted strategies, such as prescription-drug monitoring programs (PDMPs), are expensive to implement.8 Understanding the correlates of controlled-substance laws may help to promote safe, effective use of opioid analgesics and inform state investments.

relationship between legal restrictions and prescription-opioid use remains unclear, because previous research evaluated one or two laws, short time periods, or few states.4-6 Comprehensive national analyses of controlled-substance restrictions and prescription-opioid use do not yet exist.

States have responded to rising rates of prescription-opioid overdose by adopting laws that restrict the prescribing and dispensing of controlled substances. In 2010, after the adoption of many new controlled-substance restrictions, rates of prescription-opioid overdose dipped slightly before reaching a historic high in 2014.  

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