New Jersey’s ‘5-Day Rule’ Didn’t Curb Opioid Use

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While many opioid policies in New Jersey have worked to combat misuse of the drugs, one that limited the length of prescriptions did not have its intended effect, new research shows.

The legislation capped initial opioid prescriptions for acute pain at just five days.

Investigators from Rutgers University in New Jersey analyzed Medicaid records. They found that the number of people who progressed from short-term to long-term opioid use did not decline after the law went into effect.

While the new law may have cut down on leftover opioids available for misuse, it also meant that more patients needed to return to their doctors to get additional prescriptions.

Researchers noted that the number of total new prescriptions fell at a rate of 0.76 per 10,000 after the rule started. But they’d been declining at a rate of 1.62 per 10,000 before the new law.

“New Jersey has been a leader among U.S. states in combatting opioid misuse,” noted senior study author Stephen Crystal, director of the Rutgers Center for Health Services Research. “Many of its policies have worked, and new policies designed to expand access to very effective medical treatments promise to be game-changers.

“However, this policy’s apparent failure to achieve its goals illustrates the extreme difficulty of solving health care problems by dictating physician behavior,” Crystal said in a Rutgers news release.

When the U.S. Centers for Disease Control and Prevention tightened voluntary prescription guidelines, rates of opioid prescriptions fell 50% between 2013 and 2017 for New Jersey Medicaid patients. New Jersey’s 2017 regulation made many of the national guidelines mandatory.

In the study, published recently in the Journal of General Internal Medicine, Rutgers researchers analyzed six years of de-identified New Jersey Medicaid claims data for patients ages 18 to 64 who weren’t eligible for Medicare.

They linked pharmacy claims with the First Databank MedKnowledge database by National Drug Codes to identify opioid prescriptions and their duration. This allowed them to tally the number of new prescriptions and track their duration.

Just over 100,000 Americans died from drug overdoses in the year that ended April 2021, according to the CDC. That’s a 29% increase over the past year. Opioids were responsible for nearly 76,000 of those overdoses.

Still, prescription opioids serve a valuable purpose, according to the researchers.

OxyContin and Vicodin, for example, are often the most effective treatment for serious pain arising from injury and painful diseases like cancer. It may be a good thing that the state regulation did not suppress prescription totals further, they said.

“Many people feel that we have already gone too far in reducing opioid prescriptions and denying relief to people who are in serious pain,” said study lead author Peter Treitler, a research project manager at the Rutgers Institute for Health, Health Care Policy and Aging Research.

“The goal isn’t having zero opioid prescriptions; it’s having the right number going for the right duration to the right patients,” Treitler said in the release. “That’s difficult to achieve by fiat. It’s easier to achieve by educating physicians and then giving them discretion in patient treatment, as the state is doing now in letting them prescribe medication for opioid use disorders.”

More information

The U.S. Centers for Disease Control and Prevention has more on drug overdoses and deaths.

SOURCE: Rutgers University-New Brunswick, news release, Feb. 20, 2023

Source: HealthDay

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