Impact of State Policies on Opioid Prescribing Among Surgery and Injury Patients: Controlled Interrupted Time-Series Study, North Carolina, 2014-2019

Abstract

Purpose: Impact of policies limiting opioid prescribing for acute and post-surgical pain among racially minoritized populations is not well understood. We evaluated the impact of two North Carolina (NC) policies on outpatient opioid prescribing among injury and surgical patients by race, ethnicity, age, and sex.

Methods: We conducted controlled and single series interrupted time series using electronic health data from two integrated healthcare systems in NC, among > 11 years-old patients having acute injuries and surgery between April 2014 and December 2019. The policy interventions were safe opioid prescribing investigative initiative (SOPI, May 2016) and NC law limiting opioid days' supply (STOP Act, January 2018). Outcomes included, proportion of patients receiving index opioid prescription after surgery or injury event, receipt of subsequent opioid prescriptions, days' supply, and milligrams of morphine equivalents (MME).

Results: Of the 621 997 surgical and 864 061 injury patients, 69.4% and 19.7%, respectively, received an index opioid analgesic prescription. There were sustained declines in index opioid prescription among post-surgical patients after SOPI [-2.7% per year (-4.6, -0.9)] and STOP act [-4.1% (-5.9, -2.2)], but no change among injury patients. Policy-related opioid prescribing declines were larger among black, native American, and Hispanic post-surgical patients than whites and Asians. Index and subsequent opioid days' supply showed sustained declines after SOPI and STOP Act among post-surgical patients. There was no policy impact on MME.

Conclusions: Policies were associated with reductions in opioid prescribing, particularly in post-surgical patients; however, racialized inequities likely reflect implicit and explicit racialized biases in pain management practices.

Keywords: opioid prescribing; opioids; policies.