The association of state policies and opioid analgesic amount dispensed from retail pharmacies

Importance: States have implemented multiple policies likely to influence opioid prescribing; few national general population studies examine those policies' effects on per-capita opioid morphine milligram equivalents (MME) dispensed.

Objective: To examine state policies' effects on opioids per-capita MMEs dispensed at retail pharmacies.

Design: A longitudinal study of associations between MME per capita and implementation of policy interventions at different times across states.

Setting: United States, 2006-2018 PATIENTS: Data representing approximately 90 % of prescriptions filled at retail pharmacies in the United States.

Interventions: States implementing (1) Pain management clinic laws, (2) operational Prescription Drug Monitoring Programs (PDMP), (3) mandatory PDMP use, (4) required continuing medical education for opioid prescribers, (5) medical cannabis dispensary laws, and (6) initial prescription duration limit laws.

Main outcomes and measurements: Monthly county-level opioid MME per-capita.

Results: Pain management clinic policies' effects were modest, not significantly associated with MME per-capita in the year following implementation, but negatively associated in subsequent years. Operational PDMP policies were negatively associated with MME per-capita in all five years following implementation. We found no evidence of significant effects of mandatory PDMP requirements, mandatory continuing medical education policies, or medical cannabis dispensary policies in any of the five years following policy implementation. Initial prescription duration limits were associated with increased per-capita MME dispensed in years 3-5 following implementation.

Conclusions and relevance: Several state policies are associated with reductions in the total amount of opioid analgesic dispensed. Additional research should examine the policies' effects on clinical outcomes in both general and high-risk populations.