Casey Tingle , 2025-05-07 15:47:00
Key takeaways:
- New York opioid cap law reduced opioid quantities filled after total joint replacement.
- Results of this study provide a foundation to evaluate opioid cap laws in other states.
Implementation of state opioid cap laws may reduce opioid fills in the immediate 7-day postoperative period after total joint replacement, according to published results.
“Opioid cap laws are an important strategy to be able to reign in opioid prescribing, and it is important to have laws that are designed to be most effective in producing that reduction,” Caroline P. Thirukumaran, MBBS, MHA, PhD, associate professor in the department of orthopedic surgery at Northwestern University, told Healio.
Thirukumaran and colleagues analyzed data from 85,572 patients with Medicare undergoing elective TJR in New York and California between 2014 and 2019. Researchers categorized patients into groups based on whether they underwent TJR before (April 2014 to June 2016) or after (August 2016 to September 2019) implementation of state opioid cap laws in New York.
“[New York] limits the [opioid] script for acute pain to 7 days. However, it does not limit the quantity prescribed, as some other states do,” Thirukumaran said.
Primary endpoints of the study included total quantity of opioids (morphine milligram equivalents) filled from the date of discharge to 7 days post-discharge, 8 to 30 days post-discharge and 31 to 90 days post-discharge. Morphine milligram equivalents (MMEs) per prescription and day, likelihood of at least one opioid fill, number of opioid fills, likelihood of an opioid prescription longer than 7 days and days’ supply of opioids were considered secondary endpoints. The primary and secondary endpoints were compared with patients with Medicare who underwent elective TJR during the same time period in California, which did not have state opioid cap laws in place during the study period.
Results showed New York had an estimated change in total MMEs filled in the 7-day post-TJR period after vs. before implementation of the state opioid cap laws of –178 compared with –135.08 in California. This resulted in a state opioid cap law implementation-associated change of –42.92 MMEs in New York vs. California.
However, implementation of the state opioid cap law in New York was not associated with statistically significant changes in total MMEs filled in the 8- to 30-day and 31- to 90-day post-TJR periods, according to results. Thirukumaran told Healio this may be due to the possibility of physicians returning to “usual practice” after the 7-day prescription limitation.
“We did notice that providers were writing shorter scripts as well, but people were coming back more often,” Thirukumaran said. “But the net effect was that the policy was effective in reducing opioid prescribing for [patients who underwent joint replacement] and it provides a foundation to then refine New York’s policy and policies in other states and see how they do.”
For more information:
Caroline P. Thirukumaran, MBBS, MHA, PhD, can be reached at caroline.thirukumaran@northwestern.edu.
Sources/Disclosures
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Disclosures:
The National Institute on Aging (NIA) funded the study. Thirukumaran reports receiving grants from the NIA and the National Institute on Minority Health and Health Disparities; speaker honoraria from Brown University, Boston University and Mass General Brigham; reviewer honoraria from the Veterans Affairs and NIH; and serving as the disparities section editor for Current Osteoporosis Reports and Anesthesia & Analgesia.
