Opioid Prescribing Limits Linked to Rise in Opioid Prescriptions

As overdose deaths reached record-breaking highs and officials around the U.S. declared public health emergencies, the Drug Enforcement Administration (DEA) moved prescription Opioids into a more restrictive, “tougher-to-refill” group of drugs. The new Opioid prescribing limits were intended to reduce the number of prescriptions patients received and hopefully cut back on Opioid abuse, addiction, and­–in an ever-growing number of cases–overdose death. Yet, recent research shows the limits may have had an unintended effect.

In 2017, over 191 million prescriptions were dispensed in the U.S, enough for more than 75% of American adults to have their own bottle.

In 2014, the DEA recategorized painkillers like Hydrocodone (Vicodin®) from a Schedule III drug to a Schedule II–others include Oxycodone, Hydromorphone, Meperidine, Methadone, and Fentanyl. The move limited prescriptions to a 90-day supply which couldn’t be prescribed over the phone or by fax. Vicodin is one of the most commonly written prescriptions for patients after surgery and one of the most-abused prescription Opioids.

Following the schedule change, several research teams investigated the law’s effects and were stunned by the results: while prescription refill rates had fallen, patients were actually being prescribed more pills.

Why Are There More Pills?

In analyzing the data, researchers and medical professionals alike came to a general conclusion about the likely cause behind increases in prescription pill amounts.

Dr. Joe Habbouche, surgery resident at Michigan Medicine and co-author in one study of prescription rates, theorized, “Our main thought was that since surgeons were more limited in their ability to prescribe extra pain medications after the patient left the hospital, they prescribed more up front to avoid the risk of patients running out.”

However, over-prescribing Opioids also puts patients at higher risk of Opioid dependence and addiction. And, even when patients don’t use all of their prescription, leftover stockpiles of pain pills pose a threat to family and friends who may be struggling with addiction as well.

“Physician prescribing practices are a major contributor to the ongoing opioid crisis,” said Dr. Harshal Kirane, director of addiction treatment at the Staten Island University Hospital. “Yet, even the most well-intentioned prescriber is confronted by an increasingly complex calculus, in which the goals of pain management and patient satisfaction must be balanced with eliminating the risks of opioid misuse.”

In response to news of how Opioid prescribing limits have backfired, many in the addiction treatment community are calling on policymakers to include more healthcare professionals in public health decision-making.

Current State Opioid Prescribing Limits

Current Opioid prescribing limits vary widely from state-to-state. Massachusetts was the first state to impose limits on new Opioid prescriptions (reduced to 7 days) in 2016. More than half of the states have passed laws restricting prescriptions for acute pain, though little research has been done on their effectiveness.

Tennessee, Kentucky, and Florida (all states that have suffered high numbers of overdose deaths) have enacted the strictest limits on Opioids, limiting new patients to a 3- or 4-day supply. States with an initial 5-day limit include: Arizona, New Jersey, and North Carolina. States with a 7-day limit include: Alaska, Colorado, Connecticut, Hawaii, Indiana, Louisiana, Maine, Massachusetts, Missouri, New York, Oklahoma, Pennsylvania, South Carolina, Utah, and West Virginia.