Association Between State Limits on Opioid Prescribing and the Incidence of Persistent Postoperative Opioid Use Among Surgical Patients

Ann Surg. 2023 Apr 1;277(4):e759-e765. doi: 10.1097/SLA.0000000000005283. Epub 2021 Nov 9.


Objective: To examine whether laws limiting opioid prescribing have been associated with reductions in the incidence of persistent postoperative opioid use.

Summary of background data: In an effort to address the opioid epidemic, 26 states (as of 2018) have passed laws limiting opioid prescribing for acute pain. However, it is unknown whether these laws have achieved their reduced the risk of persistent postoperative opioid use.

Methods: We identified 957,639 privately insured patients undergoing one of 10 procedures between January 1, 2004 and September 30, 2018. We then estimated the association between persistent postoperative opioid use, defined as having filled ≥10 prescriptions or ≥120 days supply of opioids during postoperative days 91-365, and whether opioid prescribing limits were in effect on the day of surgery. States were classified as having: no limits, a limit of ≤7 days supply, or a limit of >7 days supply. The regression models adjusted for observable confounders such as patient comorbidities and also utilized a difference-in-differences approach, which relied on variation in state laws over time, to further minimize confounding.

Results: The adjusted incidence of persistent postoperative opioid use was 3.5% (95%CI 3.3%-3.7%) for patients facing a limit of ≤7 days supply, compared with 3.3% (95%CI 3.3%-3.3%) for patients facing no prescribing limits ( P = 0.13 for difference compared to no prescribing limits) and 3.4%, (95%CI 3.2%-3.6%) for patients facing a limit of >7 days supply ( P = 0.43 for difference compared to no prescribing limits).

Conclusions: Laws limiting opioid prescriptions were not associated with subsequent reductions in persistent postoperative opioid use.

Publication types

  • Research Support, U.S. Gov't, P.H.S.
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Pain* / drug therapy
  • Analgesics, Opioid / therapeutic use
  • Humans
  • Incidence
  • Opioid-Related Disorders* / epidemiology
  • Opioid-Related Disorders* / prevention & control
  • Pain, Postoperative / drug therapy
  • Pain, Postoperative / epidemiology
  • Practice Patterns, Physicians'


  • Analgesics, Opioid