State Comprehensive Opioid Prescribing Limits Associated With Reduced Opioid-Related Hospitalizations And ED Visits

Drug overdose deaths involving prescription opioids rose by more than 400 percent from 1999 to 2022, partly driven by overprescribing. Following 2016 Centers for Disease Control and Prevention guidelines, thirty-nine states instituted opioid prescribing limits (OPLs), with twelve adopting comprehensive OPLs combining maximum duration limits and dosage caps. However, the relationship between comprehensive OPLs and health outcomes remains unclear. Using data from the State Inpatient Databases and State Emergency Department Databases with a difference-in-differences design, we evaluated the association between state OPLs and opioid-related inpatient stays and emergency department (ED) visits during the period 2016-21. We found that the states' adoption of comprehensive OPLs was associated with a 6.2 percent decline in opioid-related hospitalizations and an 11.9 percent decline in opioid-related ED visits per 100,000 population per quarter. Stratified analyses showed that these associations were driven by adults ages 25-44 and people residing in lower income quartiles of ZIP codes. In addition, the reductions were most pronounced in states with comprehensive OPLs that included dosage caps below 90 morphine milligram equivalents per day, whereas states with only duration limits or only dosage caps did not experience similar reductions. Our findings underscore the potential importance of comprehensive OPLs in mitigating opioid-related adverse health events.