Massachusetts’ Opioid Limit Law Associated with a Reduction in Post-Operative Opioid Duration Among Orthopedic Patients

Abstract Post-operative orthopedic patients are a high-risk group for receiving long-duration, large-dosage opioid prescriptions. Rigorous evaluation of state opioid duration limit laws, enacted throughout the country in response to the opioid overdose epidemic, is lacking among this high-risk group. We took advantage of Massachusetts’ early implementation of a 2016 7-day limit law that occurred before other statewide or plan-wide policies took affect and used commercial insurance claims from 2014-2017 to study its association with post-operative opioid prescriptions greater than 7-days duration among Massachusetts orthopedic patients relative to a New Hampshire control group. Our sample included 14,097 commercially insured opioid-naïve adults aged 18 and older undergoing elective orthopedic procedures. We found that the Massachusetts 7-day limit was associated with an immediate 4.23-percentage point absolute reduction (95% CI 8.12 to 0.33 percentage points) and a 33.27% relative reduction (95% CI 55.36% to 11.19%) in the percentage of initial fills greater than 7-days in the Massachusetts relative to the control group. Seven-day limit laws may be an important state level tool to mitigate longer duration prescribing to high-risk post-operative populations.