Exploring the Impact of Opioid Prescription Limits on Duration

Study analyzed a West Virginia policy that tailored duration limits to a patient's clinical setting. Researchers found a 27-57% reduction in prescription length with the tailored policy. Additional research is needed on potential consequences of limits, such as use of illicit opioids for pain relief.

Many states have passed new laws that place restrictions on the duration of first-time opioid prescriptions to help address the opioid epidemic.

While most laws are one-size-fits-all, policies more tailored to the patient, such as their age or clinical setting (outpatient clinic, emergency room, etc.), were more effective at reducing the length of opioid prescriptions, reports a new Northwestern Medicine study.

It is the first study to examine the effectiveness of setting-specific opioid prescribing durations. The study will be published Jan. 19 in JAMA Health Forum.

The study analyzed 2017 to 2019 data from West Virginia, a state at the epicenter of the opioid crisis that in 2018 instituted a unique, setting-specific approach to prescription-duration limits. These included a seven-day limit for adult patients in outpatient hospital departments and offices; a four-day limit for adult patients in emergency departments and a three-day limit for pediatric patients in any clinical service location.

The study found tailored duration limits helped reduce the length of opioid prescriptions. There was a 56.8% reduction in prescription length amid patients in hospital and outpatient settings (seven-day limit); a 37.5% reduction in prescription length amid patients in emergency department settings (four-day limit); and a 26.5% reduction in prescription length amid pediatric patients (three-day limit).

“We have clear results that an opioid duration-limiting policy can work to reduce the length of prescriptions, but not as most states have designed them,” said corresponding author Lindsay Allen, assistant professor of emergency medicine at Northwestern University Feinberg School of Medicine.

The study also found reduced prescription lengths did not result in physicians writing stronger or more follow-up prescriptions for adults as a way of compensating for shorter prescription durations, which was a potential concern, Allen said. Instead, the policy was associated with reductions in high-dose and follow-up prescriptions in the outpatient setting.

“This could be because the law heightened concerns about lengthy opioid use, which in turn drove down doctors’ willingness to write follow-up prescriptions,” Allen said. “Also, prior to the 2018 policy, longer initial prescriptions may have built up tolerance in patients, which did not happen with shorter initial prescriptions.”

Reference: When are opioid prescription limits effective in reducing prescription length? JAMA Health Forum