Opioid limiting law and opioid prescriptions among Medicaid-enrolled survivors of childhood cancer

BACKGROUND: Many U.S. states have enacted opioid-limiting laws to curb the opioid epidemic, often capping opioid prescriptions at seven days. How these laws affect opioid prescribing among long-term survivors of childhood cancer remains unclear. METHODS: Using Medicaid claims linked to the Childhood Cancer Survivor Study, we identified childhood cancer survivors aged 18-64 years continuously enrolled in Medicaid ≥1 year during 2009-2019. Primary outcomes were any opioid prescription fill and opioid prescription with >7 days' supply. Secondary outcomes included total number of opioid prescriptions, total days of supply, and mean morphine milligram equivalents per supply day. Difference-in-differences models assessed associations between opioid-limiting law implementation and outcomes, adjusting for sociodemographic and clinical characteristics. RESULTS: We identified 2,351 survivors (57.0% female, 43.9% aged 18-29 years, 10.2% non-Hispanic Black, 9.7% Hispanic), with 15,323 person-years. Overall, 20.5% filled any opioid prescription, and 9.4% filled prescriptions with >7 days' supply. Opioid-limiting laws were associated with 1.77 percentage points (ppt; p=0.047) reduced likelihood of filling any opioid prescription with >7 days' supply. Associations with other outcomes were not statistically significant. In subgroup analyses, survivors with second cancer experienced statistically significant declines in any opioid prescriptions (-6.96 ppt, p=0.034), prescriptions with >7 days' supply (-7.79 ppts, p=0.001), total number of prescriptions (-0.42, p=0.019), and total days of supply (-7.40 days, p=0.003) following law implementation. CONCLUSIONS: While opioid-limiting laws were not associated with meaningful reductions in opioid prescribing among Medicaid-enrolled adult survivors of childhood cancer overall, notable declines were observed among subgroups with potentially higher pain care needs.