Association for Public Policy Analysis & Management

State-level legislation limiting prescriptions has been on the rise in response to the national opioid epidemic. Instituting statutory supply limits for opioid prescriptions is an increasingly prevalent strategy to address this public health crisis. Supply limitations are often integrated with more historic policy tools, especially the use of electronic online reporting programs that require physicians and other medical personnel to evaluate each patient’s medical history before prescribing controlled substances. We evaluate the use of state-level legislation to address the opioid epidemic by examining the historic progression of policy tools leveraged in Florida.

In the last decade, Florida has passed a succession of laws in response opioid abuse and misuse, first through a monitoring program, then targeting ‘pill mills,’ and finally through the adoption of a new reporting system for tracking patient prescription histories. This study evaluates how each of the database and reporting requirements developed through these legislative initiatives affected the speed and efficacy of opioid prescription management.

This longitudinal analysis draws on a survey respecting implementation of new requirements at each hospital in the state (N = 259). We match hospital survey responses to opioid overdose admissions, data on “frequent flyers” or repeated admissions, data on treatment referrals, and public reports of unintentional and undetermined drug overdose (UUDO) deaths. Preliminary results indicate that implementation and operational protocols associated with mandatory surveillance systems result in lags in communication and reduced effectiveness of opioid prescription management within and across hospitals. Variation in implementation is explained by institutional characteristics of hospitals and demographic characteristics of the communities in which they are located. We also find evidence that these surveillance systems improve over time as they become part of ‘business as usual’ in hospital settings. We find that successful implementation has a modest, lagged effect on undetermined drug overdose deaths and repeated opioid overdose admissions. We frame our findings in terms of policy learning at the state level, institutional theory the hospital level, and a policy design/implementation dichotomy across these levels.