Florida's Opioid Prescribing Law Associated With Halt in Declining Opioid Fills Among New Users

The opioid crisis has increased morbidity and mortality in the U.S. In response, states have implemented policies targeting excessive opioid prescribing. Florida's House Bill 21, enacted in 2018, required prescribers to participate in prescription drug monitoring programs and limited acute opioid prescriptions to a 3-7-day supply.

This study used a quasi-experimental interrupted time-series analysis of Florida Medicaid claims from 2016 to 2019 to evaluate whether House Bill 21 was associated with changes in opioid prescribing. The study included 2,813,775 Medicaid Managed Care enrollees with a pain-related medical claim during the study period. Analyses were stratified by prior opioid use and pain chronicity, and the primary outcome was the proportion of monthly noncancer pain-related claims linked to an opioid prescription fill.

Prior to Florida's House Bill 21, opioid fill rates were declining. Among opioid-naïve patients, the bill was associated with a positive trend change in opioid fills per month (95% CI=0.0030, 0.0034; p≤0.001), whereas patients with a history of opioid use did not have a statistically significant change in trend (0.02 percentage points per month, 95% CI= -0.0002, 0.0006; p=0.68). This pattern held for patients with acute pain and for those with chronic pain. By the end of the study period, opioid fills for opioid-naïve patients exceeded what would have been predicted if prebill trends had continued, for patients with both acute and chronic pain. The opposite pattern was observed for patients with prior opioid use.

Florida House Bill 21 was associated with significant reductions in overall opioid prescribing, but impacts differed by patient opioid history. For patients with no recent opioid use, fills increased compared with prior trends. These findings suggest that opioid-prescribing policies may have differential impacts across patient groups.