How Well Do Doctors Know Their Patients? An Analysis of Opioid Prescriptions and Must-Access Laws

“Must-access” laws are one of the most promising policies for reducing risky patterns of opioid prescription. Over the past five years, a large number of states have implemented these policies, which require doctors to access statewide patient prescription records before writing a prescription. We compare outcomes for two similar states, Kentucky and Indiana, which are at the heart of the opioid epidemic. In 2012, Kentucky passed House Bill 1, a particularly stringent must-access laws that also updated the training requirements of doctors to familiarize them with the electronic reporting system. Indiana did not introduce any form of must-access law until 2015. We perform a difference-in-differences analysis based on the universe of prescriptions filled in each state. This unique dataset allows us to control for both patient and doctor fixed effects.

Our analysis shows that House Bill 1 significantly reduced prescriptions of opioid painkillers. This effect was concentrated among patients who were most at risk of opioid abuse and doctors who wrote high volumes of prescriptions. Behaviors such as doctor shopping and pharmacy shopping also decreased significantly. We conclude that the bill successfully reduced prescriptions to patients who exhibit risky behaviors, while having little effect on the median user.