The Center for Public Health Law Research published data on the Center’s Prescription Drug Abuse Policy System legal data site PDAPS.org on state laws limiting prescriptions for opioid analgesics. This dataset presents state-level statutes and regulations across all 50 states and the District of Columbia in effect between January 1, 2014, and December 31, 2019. 

The data were created in collaboration with subject matter expert Dr. Kao-Ping Chua, MD, PhD, Assistant Professor of Pediatrics, Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan Medical School, who conceptualized this project. 

Most significantly, the data reveal that nearly all US states have laws limiting prescriptions for opioid analgesics. As of the end of December 2019, 39 states had enacted limits restricting prescriptions for opioid analgesics, with the vast majority of those limits having been enacted since 2016. 

The data also show: 

• Only three states restrict all or most opioid analgesic prescriptions to a three-day supply or less; 33 states have at least one limit requiring an opioid prescription to be for 7 days or fewer.  
• Most states have the same opioid analgesic prescription restrictions for both adults and minors, but in the seven states that regulate minors differently, the limits were more restrictive for minors.   
• In 22 states, the limit includes an exception from the opioid analgesic prescribing limit based on the professional judgement of the practitioner. 
• Three states restrict the quantity of opioids in each prescription. Maryland and Mississippi indicate that the amount of opioids prescribed should be no greater than what is needed; Rhode Island specifies the prescription may be up to 20 doses. 
• Twenty-five states restrict all initial prescriptions for patients new to opioids and/or initial prescriptions for acute pain. Ten of those states do not define “initial” in their statute or regulation. 

Dr. Chua’s team plans to update the opioid prescribing limit database through the end of 2022. The database joins more than 25 datasets on PDAPS.org covering drug policy information in the United States. 

We asked Dr. Chua a few questions about his work. 

What drew you to policy surveillance? 

KC: Since 2016, almost every state in the U.S. has implemented a policy limiting the duration and/or number of doses in opioid prescriptions for patients with acute pain, patients new to opioids, or both. We received a grant from the Benter Foundation to investigate the effects of these state opioid prescribing limits on opioid prescribing by dentists, who represent one of the most common prescribers of opioids for acute pain, particularly among adolescents and young adults. To carry out this work, we contracted with the legal epidemiologists at PDAPS to develop a comprehensive database of state opioid prescribing limits implemented through the end of December 2019.  

How do you plan to use the data you created for further research or within your practice? 

KC: Using information on the design and implementation dates of opioid prescribing limits from the PDAPS database, we are currently assessing the effects of opioid prescribing limits on opioid prescribing for dental procedures. In future NIH-funded work, we will extend these analyses to opioid prescribing for surgical procedures. 

Where should research in this area (including yours!) go from here? 

KC: Opioid prescribing limits have the potential to reduce opioid prescribing that exceeds the amount patients need, reducing leftover opioids that can be diverted or misused. At the same time, these policies also have the potential to reduce opioid prescribing below the levels that patients need, resulting in poorly controlled pain. Determining the intended and unintended consequences of opioid prescribing limits is crucial to determine whether these policies should be extended more broadly or whether other interventions are needed to prevent excessive opioid prescribing for acute pain. 

Opioid prescribing limits generally restrict the duration of opioid prescriptions by the number of days supplied. Some states additionally limit the daily dosage or total dosage allowed in opioid prescriptions. All are intended to mitigate the harm associated with prescription opioid use and misuse.