Postoperative Opioid Prescribing Among Adults with Disabilities After a Medicare Opioid Limit Policy

Determine whether a Medicare 7-day limit on initial opioid prescriptions (effective January 1, 2019) was associated with reductions in duration, dosage, and subsequent opioid fills among post-operative adults with disabilities.

Post-operative adults with disabilities are at increased risk for uncontrolled pain and extended opioid use.

We identified adults with disability entitlement aged 18-64 from national Medicare Advantage health plan claims data who underwent common surgeries between July 2016-June 2021. We used a repeated cross-sectional interrupted time series design to examine changes in opioid prescribing associated with the 2019 7-day limit.

Sample included 24,910 member-index months (mean age [SD] 55.5 [8.0] years; 14,413 [57.9%] female) representing 24,283 members. The 7-day limit was associated with an 11.8 percentage point (pp) reduction (95% CI -13.3, -10.2) in the likelihood of an initial fill >7-day supply that remained lower than predicted (-5.7 pp, 95% CI -7.6, -3.7) by June 2021. Cumulative 30-day MME was lower than predicted (-35.9 MME, 95% CI -53.7, -18.1) in January 2019 but higher than predicted by June 2021 (95.2 MME, 95% CI 56.9, 133.6). The likelihood of ≥1 fills within 30-days of the initial fill was not significantly different in January 2019 but was 6.9 pp higher (95% CI 3.1, 10.7) than predicted by June 2021.

The 2019 Medicare 7-day limit was associated with immediate large reductions in initial opioid duration and dosage. Increased dosage observed in June 2021 may have been mediated by an increase in subsequent opioid prescriptions after the initial fill.