Early Opioid Policy Response:
Impact of Policies to Curtail Opioid Prescribing
In recent years, Minnesota joined many states in passing laws that limit opioid prescribing and require prescribers to check the Prescription Drug Monitoring Program (PDMP) before prescribing opioids. Minnesota's PDMP law was enacted in 2007; on January 1, 2021, prescribers were required to check the PDMP before any initial prescription for Schedule II through IV opioids, and periodically during long-term opioid therapy. Minnesota also limits the number of days for which opioids may be prescribed.
This analysis uses national data to estimate the impact of those laws on the number and strength of opioids prescribed to Medicaid recipients. In the past decade, when many states have enacted these policies, a range of factors led to a decrease in opioid prescribing, but an increase in opioid overdose deaths. This novel analysis compares trends in states that adopted each of the policies to contemporary trends in states that had not yet adopted the policies, controlling for changes in state demographics and other policies that may affect opioid use. We find:
- In states where opioid prescribing laws were implemented, there was a statistically significant reduction in prescribing strength (-119 Morphine Milligram Equivalent per Medicaid recipient after two years) and number of prescriptions (-.13 prescriptions per Medicaid recipient after two years).
- Mandatory PDMP use laws were associated with small, but not statistically significant, declines in the number of prescriptions after three years. This analysis did not have the data necessary to examine other potential PDMP-related outcomes, like changes in either rates of dangerous co-prescribing or changes in illicit behavior by prescribers or patients. Currently, Minnesota statute (§152.126) prohibits the PDMP from sharing the data necessary to evaluate those measures.
- Neither policy was associated with decreases in either prescription-related or illicit opioid-overdoses. States that adopted prescription limit laws actually had faster increases in overall opioid mortality than states that did not, but this appears to be a continuation of trends that began before the states adopted these policies.
This report finds that steps taken by the Minnesota legislature had important, positive impacts on opioid prescribing patterns. These encouraging findings provide empirical support for Minnesota's efforts to limit opioid prescribing. Our exploratory analysis is also suggestive that more stringent requirements for prescribers to check the PDMP, like those Minnesota adopted in 2019, may not result in reductions in opioids prescribing, though additional study is needed. This analysis also provides a comprehensive 50-state scan of the application of these two policies, offering insights into what other states are doing to regulate prescribing (see Appendices A and B).
This report presents mixed findings for the associations between prescription limits and mandated use of PDMPs with changes in opioid poisoning deaths. Neither policy was associated with significantly lower prescription deaths; while overall opioid deaths increased in states that adopted prescribing limits, that appears to be a continuation of trends that began before the laws were adopted. Given this evidence and other research, a robust continuum of care—prevention, early intervention, treatment, and recovery services for opioid use disorder—is necessary to lessen the tremendous harm of opioids.