Association for Public Policy Analysis & Management

In the United States misuse of prescription opioids leads to social burden in terms of morbidity, mortality, and increased use of costly healthcare services.  According to National Survey on Drug Use and Health, an estimated 4.5 million persons aged 12 or older were current nonmedical users of prescription opioid pain relievers in 2013.  Moreover, according to the Centers for Disease Control and Prevention (CDC), 16,235 deaths and 420,040 emergency department (ER) visits were related to opioid analgesic misuse in the same year.  In 2007, prescription opioid abuse in the U.S. was estimated to cost about $55.7 billion (Birnbaum et al, 2011).  These numbers imply that the magnitude of social costs attributable to opioid misuse is substantial.

 In response, a number of state legislations and initiatives had been enacted in an effort to regulate and mitigate prescription drug abuse and diversion and its associated costs.  The CDC has identified seven state legislative strategies that could impact prescription drug misuse, abuse, and overdose: laws requiring a physical exam before prescribing, laws requiring tamper-resistant prescription forms, laws regulating pain management clinics, doctor shopping laws, laws requiring patient identification before prescribing or dispensing, time and dosage limit laws, and laws related to prescription drug overdose emergencies.

 To date, there is surprisingly little published evidence on the effectiveness of these laws.  We address this research dearth and provide new evidence on the impact of state laws designed to regulate prescription drugs.  Using a differences-in-differences design that uses variation in the timing of law implementation across states as a source of exogenous variation, we examine the impact of the state laws on several outcomes: self-reported misuse of prescription opioids, opioid overdose deaths, and healthcare utilization as measured by addiction treatment and emergency department episodes.  

Results suggest that, although these state laws do not appear to have an impact on the number of opioid abuse treatment admissions or on opioid misuse, laws requiring tamper-resistant prescription forms decrease the number of prescription opioid overdose deaths.  Moreover, doctor shopping laws and laws requiring tamper-resistant prescription forms slightly increase the number of heroin overdose deaths.  This pattern of results suggests that individuals may substitute heroin for prescription opioids when consumption of the latter becomes more costly.  

 Overall, our findings suggest that the state laws designed to regulate prescription drugs have little to no effect on the outcomes studied.  Information on the effectiveness of these state laws provides critical and timely information for policy makers as they decide how best to regulate prescription drugs and minimize associated social harms.    

 References:

1. Birnbaum, H. G., White, A. G., Schiller, M., Waldman, T., Cleveland, J. M., & Roland, C. L. (2011). Societal costs of prescription opioid abuse, dependence, and misuse in the United States. Pain Medicine, 12(4), 657-667.