Assessing the Effectiveness of State Policies for Altering Opioid Use and Misuse Among Medicare Beneficiaries

In response to the burgeoning opioid epidemic, state governments are experimenting with a wide variety of laws aimed at reducing improper opioid utilization. However, the impact of these laws is largely unmeasured. To determine whether these laws are meeting their intended end, I test their impact on three measures of opioid utilization, three measures of opioid misuse, and three measures of physician prescribing in a 20 percent random sample of Medicare medical and prescription drug claims. I find that two categories of state laws—stricter regulation of pain management clinics and use of tamper-resistant prescription pads—are associated with consistent, significant reductions of measures of opioid utilization, misuse, and physician prescribing. The two laws affect distinct margins with tamper-resistant prescription laws reducing the frequency of prescribing and pain management clinic regulations reducing the strength of opioid prescriptions. Other laws—including the oft-cited prescription drug monitoring programs—do not have consistent or significant effects on opioid outcomes. I also find suggestive evidence that the laws lessen utilization across many categories of opioid users. For example, I find reductions in opioid prescriptions among opioid users with both acute and chronic pain diagnoses. These pieces of evidence suggest that while some laws are having measurable impacts, many of these laws should be reconsidered or reformulated prior to widespread adoption.