Association Between State Opioid Prescribing Limits and Duration of Opioid Prescriptions From Dentists

This cross-sectional study assesses whether state-specific implementation of opioid prescribing is associated with a shorter duration of opioid prescriptions from dentists for children and adult dental patients. Key Points QuestionAre state opioid prescribing limits associated with reductions in the duration of opioid prescriptions from dentists? Findings In this cross-sectional study of nearly 90 million dental opioid prescriptions dispensed to adults and children in the US from January 2014 through February 2020, the median duration of these prescriptions was 3.0 days. Implementation of state opioid prescribing limits, most of which allowed up to a 7-day supply of opioids, was not associated with changes in the duration of these prescriptions. Meaning The findings of this study suggest the need for future research evaluating the potential role of alternative interventions in reducing dental opioid prescribing. Importance In part to prevent the harms associated with dental opioid prescriptions, most states have enacted policies limiting the duration of opioid prescriptions for acute pain. Whether these limits are associated with changes in the duration of opioid prescriptions written by dentists is unclear. Objective To evaluate the association between state opioid prescribing limits and the duration of opioid prescriptions from dentists. Design, Setting, and Participants This difference-in-differences cross-sectional study used data from the IQVIA Longitudinal Prescription Database, an all-payer database reporting prescription dispensing from 92% of retail pharmacies in the US. The sample included opioid prescriptions from dentists dispensed to children aged 0 to 17 years and adults 18 years or older from January 2014 through February 2020. Treatment states were those that implemented limits between January 2016 and December 2018. Control states were those that did not implement limits during the study period. Data on opioid prescribing limits were derived from the Prescription Drug Abuse Policy System. Data were analyzed from January 1 to September 30, 2022. Exposures State opioid prescribing limits. Main Outcomes and Measures The outcome was opioid prescription duration, as measured by days' supply. The association between limits and duration was evaluated using a linear model with a 2-way fixed-effects specification. Covariates included patient characteristics, prescription characteristics, and indicators of implementation of prescription drug monitoring program use mandates. Separate analyses of data from adults and children were conducted owing to differences in the number of treatment states and restrictiveness of limits by age. Results The adult analysis included 56607 314 opioid prescriptions for 34364775 patients (18448788 females [53.7%]; mean [SD] age at the earliest fill, 44.0 [17.4] years) in 22 treatment states and 12 control states. The child analysis included 3720837 opioid prescriptions for 3165880 patients (1740449 females [55.0%]; mean [SD] age at the earliest fill, 14.4 [3.5] years) in 23 treatment states and 12 control states. In both analyses, the median (25th-75th percentile) duration of opioid prescriptions was 3.0 (2-5) days. Implementation of limits, most of which allowed up to a 7-day supply of opioids, was not associated with changes in the duration of opioid prescriptions for adults (mean days' supply: -0.06 days; 95% CI, -0.11 to <0.001 days) or children (mean days' supply: -0.07 days; 95% CI, -0.15 to 0.02 days). Conclusions and Relevance In this study of national pharmacy dispensing data, opioid prescribing limits were not associated with changes in the duration of opioid prescriptions from dentists. Future research should investigate the potential role of alternative interventions in reducing opioid prescribing by dentists.