Opioid prescription limits and policies by state

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Opioids are a class of drugs that are derived from the opium poppy (or, in the case of pharmaceuticals, made synthetically) and bind to nerve cells, inhibiting pain signals. Vicodin, OxyContin, and morphine are all examples of opioids. On November 1, 2011, the Centers for Disease Control and Prevention (CDC) issued a press release stating that overdoses from prescription opioid painkillers had reached epidemic levels.

HIGHLIGHTS

On March 31, 2021, North Dakota Gov. Doug Burgum (R) signed House bill No. 1139 into law, amending the North Dakota Century Code to prohibit organizations from paying for opioid therapy exceeding 90 morphine milligram equivalents, or more than a seven-day supply of opioid medication in the first 30 days of opioid therapy.

In March 2016, Massachusetts became the first state to enact legislation to limit the initial supply of opioid painkillers prescribed by doctors.

As of January 2022, 38 states had implemented policies or guidelines setting limits on the supply of opioids that can be prescribed by doctors. The opioid limits in five of those states only apply to Medicaid recipients. Two of those states have no set pill or day limit for opioid prescriptions but require doctors to prescribe the lowest effective dose.

Supporters of opioid limits such as the Centers for Disease Control and Prevention argue that "prescriptions with fewer days' supply will minimize the number of pills available for unintentional or intentional diversion." Opponents of the laws such as physicians Stefan G. Kertesz, MD, and Adam J. Gordon, MD argue that while the laws "could help some, it will destabilize others and likely promote the use of heroin or other drugs."

Of the 38 states with opioid limits, 17 were controlled by Republican trifectas when the limits were adopted, five were controlled by Democratic trifectas, and 16 were under divided government. Twenty-five states set opioid prescription limits through legislation, two states set opioid limits through an executive order, and 11 states authorized another organization to set limits or guidelines. For the most up-to-date information on state government trifectas, see here.

State policies

The section below is current as of April 4, 2022. If we are missing any policies, please e-mail Ballotpedia's Editor.

Alabama

• Current limit: Seven-day limit (adults) and five-day limit (minors) (Medicaid recipients only, excluding hospice, long-term care and cancer patients)
• Policy: The Alabama Medicaid Agency implemented a policy on November 1, 2018, which limited short-acting prescription opioids for patients without an opioid claim history in the past 180 days. The policy established a maximum supply of seven days for adults and five days for children, with a 50 morphine milligram equivalent (MME) limit per day. The AMA implemented a policy on August 1, 2019, to decrease the daily cumulative MME limit by 50 MME every four months until it reached 90 MME per day (the Center for Disease Control and Prevention recommendation).

Alaska

• Current limit: Seven-day initial limit (adults) and seven-day limit (minors)
• Policy: Gov. Bill Walker (I) signed House Bill 159 into law on July 25, 2017. The legislation limits the first fill prescription of opioids to a seven day supply. Prescriptions can exceed seven days if a doctor provides a valid reason for why a longer prescription is needed. Valid reasons for an extension include logistical or travel barriers and if a patient needs more pills to manage chronic pain. The legislation also requires opioid prescription training for medical professionals.
• At the bill's signing ceremony, Gov. Walker made the following statement: "I introduced this legislation as a part of our multi-pronged effort to fight the opioid epidemic facing Alaska, and I’m incredibly pleased to be able to sign it today. One death resulting from opioid abuse or misuse is too many, and we must tackle this issue head-on as Alaskans. HB 159 is an example of healthcare providers, legislators, and Alaskans pulling together to build a safer state as a community. I thank Rep. Spohnholz, Sen. Micciche, Chief Medical Officer Dr. Jay Butler, and countless others for all of the work put into this legislation. It is my sincere hope that lives will be changed as a result of it."

Arizona

• Current limit: Five-day initial limit
• First policy: Gov. Doug Ducey (R) signed an executive order on October 24, 2016, that set opioid prescription limits for anyone insured under the state's Medicaid program or the state's employee insurance plan. The order limits the first fill prescription of opioids for adults to seven days. No opioid prescriptions are permitted for children unless they have cancer, a chronic disease, or suffer a traumatic injury. "This is a preventive step, and one we hope that employers and insurance companies will follow our lead to address the scourge of addiction on the front end," said Gov. Ducey on the executive order.
• Second policy: On January 26, 2018, Gov. Doug Ducey (R) signed Senate Bill 1001, known as the Arizona Opioid Epidemic Act. The legislation limited the first fill prescription of adults to five days and aligned state dosage levels with federal guidelines; invested $10 million to assist in improving access to treatment; expanded law enforcement's access to Naloxone, a drug used to reverse overdoses; enacted continuing medical education for opioid prescribers; and required e-prescribing, among other provisions. The legislation passed unanimously in the Arizona State Legislature.

Colorado

• Current limit: Seven-day initial limit (long-term care excluded)
• First policy: Colorado's Department of Health Care Policy and Financing announced a new policy on July 10, 2017, to reduce opioid prescriptions in the state's Medicaid program. The policy was rolled out in two phases. The first phase went into effect on August 1, 2017, and limits the supply of opioids a Medicaid recipient can receive if they did not have an opioid prescription in the past 12 months. The policy limits the first fill prescription of opioids to a seven day supply. Patients can get two more seven-day prescriptions, but a fourth prescription would have to be approved by the department. Medicaid recipients that already had an opioid prescription before the new policy will still be allowed up to a 30-day prescription. The second phase went into effect on October 1, 2017, and reduced the morphine milligram equivalents (MME) from Medicaid patients from 300 MME per day to 250 MME per day. The new MME limit does not apply to patients being treated for cancer or in palliative or hospice care.
• Second policy: On May 21, 2018, Gov. John Hickenlooper (D) signed Senate Bill 22 into law. The bill implemented a seven-day initial limit on opioid prescriptions, with prescribers allowed to write another seven-day prescription if they consider it necessary. The bill included exemptions for patients experiencing chronic pain, cancer patients, patients under hospice care, and patients experiencing post-surgical pain expected to last longer than 14 days.

Connecticut

• Current limit: Seven-day initial limit (adults) and five-day limit (minors)
• First policy: Gov. Dan Malloy (D) signed House Bill 5053 into law on May 27, 2016. This legislation limits the first fill prescription of opioids to seven days. Prescriptions can exceed seven days if a doctor determines that the acute or chronic pain condition requires it. The legislative also limited opioid prescriptions for minors to seven days.
• Second policy: Gov. Dan Malloy (D) signed House Bill 7052 into law on June 30, 2017. This bill reduced opioid prescriptions for minors from seven days to five days. At the bill's signing ceremony, Gov. Malloy made the following statement: "Opioid addiction and prescription drug abuse is a disease that is impacting nearly every community and people of every background. It is a complex crisis that does not have one root cause, nor does it have simple solution, but we need to do everything in our power to treat and prevent it. Our work on this front will not be finished until our communities and our families are no longer struggling with the grave costs of this illness."

Delaware

• Current limit: Seven-day initial limit (adults) and seven-day limit (minors)
• Policy: Delaware's Division of Professional Regulation set limits on opioid prescriptions on April 1, 2017. The new rules limit the first fill prescription of opioids to seven days for adults. The rules also limit opioid prescriptions for minors to seven days. Prescriptions can exceed seven days if a doctor determines that the patient requires it. If the doctor deems that a larger supply is necessary, the patient must undergo a physical exam, be educated about the dangers of opioid abuse, and the doctor must examine the patients prescription history.
• Secretary of State Jeff Bullock (D), whose department regulates controlled substances, made the following statement: "These regulations can save lives by helping to curb the abuse of opiates in our state. Delaware’s prescription rate for certain opiates is among the highest in the nation, according to the Centers for Disease Control, and we know what many users of heroin tell us: Their drug abuse can be traced back to a time when they were prescribed opiates for an injury or some other valid medical need. With these regulations, we are supporting the efforts of those seeking to break that cycle – including doctors, pharmacists, public health workers and our law enforcement agencies."

Florida

• Current limit: Three-day limit (acute pain)
• Policy: Gov. Rick Scott (R) signed opioid legislation that places a three-day limit on prescribed opioids for acute pain, with some exceptions for a seven-day prescription. The law requires healthcare providers to verify a patient's medication history by checking a statewide database of controlled substance prescriptions and mandates that doctors participate in continuing education courses for prescribing opioids. It increases penalties for providers that prescribe opioids through fraudulent or deceptive methods and establishes measures to limit unlicensed pain management clinics. Gov. Scott also noted that the state's fiscal year 2019 budget included $65 million to combat the opioid crisis.

Hawaii

• Current limit: Seven-day initial limit
• Policy: Gov. David Ige (D) signed Senate Bill 505 into law on July 3, 2017. This legislation limits initial opioid and benzodiazepines prescriptions to no longer than seven consecutive days. Prescriptions can exceed seven days under certain circumstances, such as treatment for cancer, someone in palliative care, and post-operative care.

Indiana

• Current limit: Seven-day initial limit (adults) and seven-day limit (minors)
• Policy: Gov. Eric Holcomb (R) signed Senate Bill 226 into law on April 26, 2017. The law went into effect on July 1, 2017. Senate Bill 226 limits the first fill prescription of opioids to seven days for adults. The law also limits opioid prescriptions for minors to seven days. Prescriptions can exceed seven days under certain circumstances, such as the doctor determines that the patient requires it and if the patient is in palliative care.
• At the bill's signing ceremony, Gov. Holcomb made the following statement: "The opioid crisis is negatively impacting the lives of Hoosiers, their families, our communities—even our economy. I commend lawmakers for supporting my initiatives and delivering a package of legislation that provides a holistic framework for us to attack this epidemic."

Iowa

• Policy: Gov. Kim Reynolds (R) signed HB 2377 on May 14, 2018. The law requires doctors to register for and use prescription monitoring program, establishes criteria for recognizing patients at high risk for abuse and addiction, requires electronic prescribing, and allows licensing boards to evaluated penalties for healthcare providers who overprescribe.

Kentucky

• Current limit: Three-day initial limit
• Policy: Gov. Matt Bevin (R) signed House Bill 333 into law on April 10, 2017. The law officially went into effect on June 29, 2017. The law limits initial opioid prescriptions for acute pain to three days. Prescriptions can exceed three days under certain circumstances. Patients can receive a larger supply if the medical provider determines that its necessary to treat chronic pain, cancer-related pain, and pain after surgery.

Louisiana

• Current limit: Seven-day initial limit (adults) and seven-day limit (minors)
• Policy: Gov. John Bel Edwards (D) signed House Bill 192 into law on June 12, 2017. The law officially went into effect on August 1, 2017. The law limits initial opioid prescriptions for acute pain to seven days. The law does not apply to patients with chronic pain, cancer, or patients receiving hospice care.
• Gov. Bel Edwards made the following statement after the bill passed the Louisiana State Legislature: "Given the increasing abuse of opioids in our state and nation, these bills could save the lives of those who are at risk of becoming addicted and consequently prevent their family and friends from the heartache that comes from seeing their loved-ones suffer. I am appreciative of the bipartisan work of Representatives Moreno and Talbot for working with our state’s health care providers and each other on behalf of the people of Louisiana. Their concern for our citizens as well as those lawmakers who also supported the bills proves that when it comes to doing what’s right, our focus should be and can be on our people rather than politics."

Maine

• Current limit: 100 morphine milligram equivalents (MME) per day, seven-days (acute pain), and 30 days (chronic pain)
• First policy: Gov. Paul LePage (R) signed L.D. 1646 into law on April 19, 2016. The law set a seven-day limit on opioid prescriptions for acute pain and a 30-day limit on opioid prescriptions for chronic pain. Under the new law, patients may also not exceed 100 MME per day. In some cases, patients can exceed their prescription limits and MME limits for cases such as cancer pain, hospice and palliative care, and treatment for a substance abuse disorder.
• Second policy: Gov. Paul LePage (R) signed LD 1031 on June 16, 2017, which clarified the exceptions to the MME limit in L.D. 1646. The law clarified to medical professionals that patients could receive more than 100 MME per day if they suffered from chronic pain, cancer pain, were under hospice and palliative care, or were in treatment for a substance abuse disorder.

Maryland

• Current limit: No set pill or day limit. Must prescribe lowest effective dose.
• Policy: Gov. Larry Hogan (R) signed House Bill 1432 on May 25, 2017. The legislation requires medical professionals to prescribe the lowest effective dose of an opioid.
• At the bill's signing ceremony, Gov. Hogan made the following statement: "These critical initiatives will help us continue to lead the charge against Maryland’s heroin and opioid crisis in our state. Our administration remains committed to treating this crisis like the emergency that it is, and I thank the legislature for working with us to provide additional tools to save the lives of Marylanders – before it’s too late."

Massachusetts

• Current limit: Seven-day initial limit (adults) and seven-day limit (minors)
• Policy: Gov. Charlie Baker (R) signed House Bill 4056 into law on March 14, 2016. The law limits initial opioid prescriptions to seven days for adults. The law also limits opioid prescriptions for minors to seven days. Prescriptions can exceed seven days under certain circumstances, such cancer pain, chronic pain, and for palliative care.
• At the bill's signing ceremony, Gov. Baker made the following statement: "Today, the Commonwealth stands in solidarity to fight the opioid and heroin epidemic that continues to plague our state and burden countless families and individuals. I am proud to sign this legislation marking a remarkable statewide effort to strengthen prescribing laws and increase education for students and doctors. While there is still much work to be done, our administration is thankful for the legislature’s effort to pass this bill and looks forward to working with the Attorney General and our mayors to bend the trend and support those who have fallen victim to this horrific public health epidemic."

Michigan

• Current limit: Seven-day limit for acute pain
• Policy: In December 2017, Lt. Gov. Brian Calley (R) signed a package of 10 bills related to opioids. The bills required parentel consent before prescribing opioids to a minor and established sanctions for prescribers who fail to inform minors of the risks of opioid abuse; required a doctor to have a prescriber-patient relationship with the patient and conduct follow-up care after prescribing opioids; and limited prescriptions for acute pain to seven days.

Minnesota

• Current limit: Four-day limit (acute dental or ophthalmic pain)
• Policy: Gov. Mark Dayton (D) signed SF 2a into law on May 30, 2017. The legislation limits opioid presciptions for acute dental or refractive surgery pain to four-days.

Missouri

• Current limit: Seven-day initial limit (Medicaid recipients only)
• Policy: Missouri's Medicaid program adopted a new policy on March 27, 2017, to reduce opioid prescriptions in the state's Medicaid program. The new initiative limits initial opioid prescriptions to seven days.
• On July 11, 2019, Missouri passed SB 514, requiring dentists to document and explain prescriptions of extended-release opioids or doses greater than 50 morphine milligram equivalents for the treatment of acute pain.

Nebraska

• Current limit: 150 tablets per 30-days (Medicaid recipients only), seven-day limit (patients under the age of 19)
• First policy: Nebraska's Medicaid program adopted a new policy on October 1, 2016, to reduce opioid prescriptions in the state's Medicaid program. The state will limit Medicaid recipients to 150 doses of short-acting opioids in 30 days.
• After the opioid prescription changes were announced, Gov. Pete Ricketts (R) made the following statement: "The consequences of opioid abuse can be devastating, as national statistics demonstrate. I applaud DHHS for taking decisive action on this pervasive problem to ensure that our citizens stay healthy. DHHS’s collaborative efforts will benefit many Nebraskans, and I hope that anyone suffering from dependency to these drugs will seek out help from an opioid addiction treatment program."
• Second policy: On April 4, 2018, Gov. Pete Ricketts (R) signed LB 931, which limited opioid prescriptions to seven days for patients under the age of 19, directed healthcare providers to discuss the risks of addiction with patients receiving opioids, and required photo identification for patients receiving dispensed opioids. The Nebraska State Legislature unanimously passed the legislation.

Nevada

• Current limit: 90 morphine milligram equivalents (MME) per day and 14-day initial limit (acute pain)
• Policy: Gov. Brian Sandoval (R) signed Assembly Bill 474 into law on June 16, 2017. The law set a 14-day initial limit on opioid prescriptions for acute pain. Under the new law, patients may also not exceed 90 MME per day. If a patient requires more than 30 days, the doctor must consider 16 factors, such as if the treatment is working and if the patient is doctor shopping. If a patient requires more than 90 days of pills, patients must undergo blood and radiology tests to determine the cause of the pain.

New Hampshire

• Current limit: Seven-day limit
• Policy: Gov. Maggie Hassan (D) signed House Bill 1423 into law on June 7, 2016. The law requires the state Board of Medicine, the state Board of Dental Examiners, the state Board of Nursing, the state Board of Registration in Optometry, the state Board of Podiatry, the state Naturopathic Board of Examiners, and the state Board of Veterinary Medicine to adopt rules for prescribing controlled drugs. The rules went into effect on January 1, 2017.
• The rules forbid medical professionals from prescribing opioid prescriptions more than seven-days in an emergency room, urgent care setting, or walk-in clinic. The rules also require that pain patients be prescribed the lowest effective dose of pain medications.

New Jersey

• Current limit: Five-day initial limit (acute pain)
• Policy: Gov. Chris Christie (R) signed Senate Bill 3 into law on February 15, 2017. The law reduced initial opioid prescriptions from 30 days to five days for acute pain. The law also requires healthcare providers to offer 180 days of substance abuse disorder treatment without preauthorization. This law does not apply to people undergoing cancer treatment, receiving hospice care, in a long-term care facility, or to any medications prescribed for treatment of substance abuse.
• At the bill's signing ceremony, Gov. Christie made the following statement: "I’m pleased to have signed Senate Bill 3. That’s also a good indicator that I knew it was going to pass, when they give it a low number it’s pretty good. A bi-partisan measure which requires health insurance coverage for treatment of substance abuse disease as well as providing the country’s strongest maximum limit of five days on initial opioid prescriptions, which often become a gateway to addiction and in fact, according to Pew, four out of five new heroin victims, new addicts to heroin start with prescription opioid drugs. Most states allow opioid prescriptions to last seven days or many states significantly longer, New Jersey will now lead the way in that regard. When a person who is in the throes of addiction as you know realizes he or she needs help, they should not be blocked at the treatment center doors with their life hanging in the balance, because their insurance carrier requires a pre-evaluation that could take weeks to complete. Now, with this legislation, people seeking treatment cannot be denied access in their time of need."

New York

• Current limit: Seven-day initial limit (acute pain)
• Policy: Gov. Andrew Cuomo (D) signed Senate Bill 8139 into law on June 22, 2016. The law reduced initial opioid prescriptions from 30 days to seven days for acute pain. This law does not apply to people suffering from chronic pain, cancer pain, and patients in hospice and palliative care.
• At the bill's signing ceremony, Gov. Cuomo made the following statement: "New York is leading the way forward in the fight against heroin and opioid addiction, and with this legislation, we are taking an affirmative stand for our families and communities who have suffered from this epidemic’s debilitating effects. I commend the Senate and the Assembly for their hard work and dedication to stopping this epidemic and creating a stronger and healthier New York."

North Carolina

• Current limit: Five-day initial limit (acute pain) and seven-day (post-operative)
• Policy: Gov. Roy Cooper (D) signed House Bill 243 into law on June 29, 2017. The law limits initial opioid prescriptions for acute pain to five days. The law also limits opioid prescriptions to a seven-day supply for patients after surgery. The law allows for exemptions for cancer patients, chronic pain, hospice and palliative care, or medications prescribed for the treatment of substance use disorders.
• At the bill's signing ceremony, Gov. Cooper made the following statement: "Opioid addiction and overdose have ravaged the physical and mental health of thousands of North Carolinians, hurting our people and our economy, and we’re taking action to fight it. With this legislation and the new State Opioid Action Plan, we’re taking important first steps to stem the opioid epidemic."

North Dakota

• Current limit: Seven-day limit, and 90 morphine milligram equivalents (MME) during the first 30-days of treatment (policy limits payment by organizations for higher dosages)
• Policy: Gov. Doug Burgum (R) signed House bill No. 1139 on March 31, 2021. The bill, effective July 1, 2022, amended the North Dakota Century Code to prohibit organizations from paying for opioid therapy exceeding 90 MME, or more than a seven-day supply of opioid medication in the first 30 days of opioid therapy.

Ohio

• Current limit: Seven-day limit (adults), five-day limit (minors), and 30 morphine equivalent dose (MMD) per day (acute pain)
• Policy: Gov. John Kasich (R) announced new opiate prescribing limits in March 2017. The new rules set by the Ohio Medical, Dental and Nursing Boards went into effect on August 31, 2017. The rules limit opioid prescriptions to no more than a seven-day prescription for adults with acute pain. Minors may be prescribed no more than a five-day prescription with written consent by a parent or guardian. The rules also limit patients with acute pain to an average of 30 morphine equivalent dose (MMD) per day. The rules do not apply for cancer patients, chronic pain, hospice and palliative care, or medications prescribed for the treatment of substance use disorders.
• At the press conference to announce the new opioid limits, Gov. Kasich made the following statement: "By reducing the availability of unused prescription opiates, fewer Ohioans will be presented with opportunities to misuse these highly addictive medications."

Oklahoma

• Current limit: Seven-day limit
• Policy: Gov. Mary Fallin (R) signed Senate Bill 1446 May 2, 2018. SB 1446 established limits on prescription opioids, prohibiting practitioners from prescribing more than a seven-day supply for patients with acute pain. The law went into effect November 1, 2018.

Oregon

• Current limit: No set pill or day limit. Recommends lowest effective dose.
• Policy: The Oregon Health Authority is responsible for setting statewide prescribing guidelines. Oregon has no set limit on opiates but recommends that medical professional prescribe the lowest effective dose.

On October 25, 2018, the Oregon Health Authority released guidelines for prescribing opioids for acute pain. The guidelines said, "Opioids should only be prescribed when necessary for acute painful conditions." The agency also said, "These statewide guidelines are intended for patients who have had limited exposure to opioids in the past. They are not intended for those who currently receive opioids nor for those with a history of substance use (or opioid use) disorder." The guidelines continued to encourage prescribing the lowest effective dose for cases in which a medical professional found it appropriate to prescribe opioids.

Pennsylvania

• Current limit: Seven-day limit (emergency rooms/urgent care centers) and seven-day limit (minors)
• First policy: Gov. Tom Wolf (D) signed Senate Bill 1367 into law on November 2, 2016. The law limits opioid prescriptions for minors to no more than a seven-day supply. Medical professionals can prescribe more than a seven-day supply if its required to stabilize the minor’s acute pain. The law allows for exemptions for cancer patients, chronic pain, and hospice and palliative care.
• Second policy: Gov. Tom Wolf (D) signed House Bill 1699 into law on November 2, 2016. The law limits emergency departments and urgent care centers from prescribing more than a seven-day supply of opioids. The law also bans doctors working in emergency departments and urgent care centers from writing refills for opioid prescriptions. The law allows exemptions for doctors to prescribe more than a seven-day supply if they determine its necessary. Doctors may prescribe more if its to treat a patient's acute pain or to treat pain associated with cancer or palliative care.
• At the signing ceremony for the two bills, Gov. Wolf made the following statement: "I am proud to sign a package of bills that represents the work that we have all done together to address the heroin and opioid abuse crisis, and begins to curb the effects of this public health epidemic in Pennsylvania. Four weeks ago, I addressed a joint session of the General Assembly to outline a set of legislative goals that would help us tackle this public health crisis and together, the General Assembly and my administration committed to help the victims of substance use disorder, and the communities that have been devastated by this terrible disease."

Rhode Island

• Current limit: 30 morphine milligram equivalents (MME) per day, seven-day limit (first-time prescriptions for adults), seven-day limit (minors)
• First policy: Gov. Gina Raimondo (D) signed Senate Bill 2823 and House Bill 8224 on June 28, 2016. The legislation limits initial opioid prescriptions for adults suffering from acute pain to 30 morphine milligram equivalents per day, for a maximum of 20 doses. It does apply to patients with cancer pain, chronic pain, and hospice and palliative care. The legislation also requires pharmacies to transmit prescription information to the prescription monitoring database within twenty-four hours of dispensing an opioid.
• Second policy: Gov. Gina Raimondo (D) signed House Bill 5537 on July 8, 2019. The bill limited first-time opioid prescriptions for adults to a seven-day supply and put the same limit on all prescriptions for minors.

Texas

• Current limit: Ten-day limit
• Policy: Gov. Greg Abbott (R) signed House Bill 2174 into law on June 14, 2019. The law took effect September 1, 2019, and required prescribers to limit opioid prescriptions for acute pain to a ten-day supply, as well as prohibiting refill of opioid prescriptions. The measure did not apply to opioids prescriped for chronic pain, cancer treatment, or hospice and palliative care. It also excluded opioids prescribed to treat substance addiction, as long as the drug has been specifically approved for that use by the Food and Drug Administration.

South Carolina

• Current limit: Five-day limit or 90 morphine milligram equivalents (MMEs) daily
• Policy: Effective May 1, 2018, South Carolina required prescribers to limit initial opioid prescriptions for acute pain or post-operative pain to the lowest effective dose. The state limited the supply to five days or 90 morphine milligran equivalents (MMEs) per day, except for cases of chronic pain, cancer pain, sickle cell disease-related pain, pallliative care, or medicatio-assisted treatment for substance abuse disorder.

Tennessee

• Current limit: Three-day initial limit for new patients
• Policy: In May 2018, Gov. Bill Haslam (R) signed HB 1831, which established a three-day opioid supply limit. The law allows for 10-day or 30-day prescriptions if certain requirements are met.

Utah

• Current limit: Seven-day initial limit (acute pain)
• Policy: Gov. Gary R. Herbert (R) signed House Bill 50 into law on March 22, 2017. The law limits the first fill prescription of opioids to seven days for acute pain. The law does not apply to patients suffering from complex or chronic conditions.

Vermont

• Current limit: Limits vary between adults and minors
• Policy: The Vermont Department of Health established new opioid rules on July 1, 2017. Doctors must assess non-opioid and non-drug treatments before prescribing opioids. Doctors must also discuss their treatment decisions with patients.
• The opioid limits are broken up into four categories: minor, moderate, severe, and extreme pain. According to the rules, adults suffering from moderate pain are allowed an average of 24 morphine milligram equivalents (MME) per day. Patients with severe pain are allowed an average of 32 morphine milligram equivalents (MME) per day. The table associated with the new rules also gives examples of the types of injuries and conditions that are commonly associated with that pain category. Minors suffering from moderate to serve pain are allowed an average of 24 morphine milligram equivalents (MME) per day. Find more on the specific pain categories here.

Virginia

• Current limit: Seven-day limit (acute pain)
• Policy: The Virginia Board of Medicine adopted new regulations relating to opioid prescriptions on February 16, 2017. Gov. Terry McAuliffe (D) signed the regulations on March 13, 2017. The regulations became effective on March 15, 2017.
• The regulations break down the prescribing limits for opiates between acute pain and chronic pain. The regulations define acute pain as pain that lasts less than three months. If a medical professional determines that opioids are required for acute pain, the regulations limit the provider from prescribing more than a seven-day supply. Patients prescribed opioids for post-surgical pain are limited to a 14-day supply. For acute pain and pain related to surgery, medical professional may not prescribe a longer supply unless “extenuating circumstances are clearly documented in the medical record.”
• The regulations define chronic pain as pain that lasts more than three months. The regulations do not give a specific limit on opioid prescriptions. Medical professionals are required to document reasons for why a patient is prescribed more than 50 morphine milligram equivalents per day. If a provider prescribes more than 120 morphine milligram equivalents per day, the doctor must document reasons for it and refer or consult with a pain management specialist. Find more on information on the regulations here.

Washington

• Current limit: Medicaid program- 20 years and younger (18 tablets) and 21 years and older (42 tablets)
• Policy: Gov. Jay Inslee (D) signed HB1427 on May 16, 2017. It became effective on July 23, 2017. This legislation requires certain boards and commissions to adopt rules establishing requirements for prescribing opioid drugs. These boards and commissions were directed to adopt rules for the management of chronic non-cancer pain through HB2876, which was signed through a partial veto on March 25, 2010. The five entities affected by the legislation are the Medical Quality Assurance Commission, Board of Osteopathic Medicine and Surgery, Nursing Care Quality Assurance Commission, Dental Quality Assurance Commission, and Podiatric Medical Board.
• The Washington Health Care Authority began to the limit opioid prescriptions for short-term use on November 1, 2017, for Medicaid patients. Washington Apple Health, the state's Medicaid program, will limit people under the age of 20 to 18 tablets. This is about a three-day supply. People 21 years and older will be limited to 42 tablets. This is about a seven-day supply. Prescribers can exceed the limits if they determine its necessary. The limits do not apply to cancer patients who are in hospice and palliative care and patients that have filled a long-term opioid prescription in the last 120 days.

West Virginia

• Current limit: Seven-day (short-terrm pain), four-day (emergency room prescriptions), three-day (prescribed by dentists or optometrists)
• Policy: Gov. Jim Justice (R) signed Senate Bill 273 on March 27, 2018. The legislation enacted procedures for opioid treatment and limited prescriptions to a seven-day period for short-term pain, four days for emergency room prescriptions, and three days for prescriptions written by a dentist or optometrist. The bill also required the state Pharmacy Board to coordinate with the physician licensing board to identify suspicious prescriptions. SB 273 did not limit opioid prescriptions for cancer and hospice patients or residents of nursing homes and long-term care facilities.

Background

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On November 1, 2011, the Centers for Disease Control and Prevention (CDC) issued a press release stating that overdoses from prescription painkillers had reached epidemic levels. The release specifically referenced "narcotic pain relievers like hydrocodone (Vicodin), methadone, oxycodone (OxyContin), and oxymorphone (Opana)." These medications are also known as opioids. Opioids are a class of drugs that are derived from the opium poppy (or, in the case of pharmaceuticals, made synthetically) and bind to nerve cells, inhibiting pain signals. Other opioids include morphine, codeine, and heroin.

According to the CDC, drug overdoses due to opioids quadrupled between 1999 and 2015, and in 2014, nearly 61 percent of drug overdoses were due to opioids. In 2015, over 31,000 people nationwide died from opioid overdoses, over half of which were from prescription opioids. Overdose deaths involving opioids in 2015 amounted to 10.4 per 100,000 population nationwide, compared to 3 per 100,000 population in 2000.

In a November 2016 report, the Surgeon General of the United States described the cause of the overdose epidemic in the following way:

“	Over-prescription of powerful opioid pain relievers beginning in the 1990s led to a rapid escalation of use and misuse of these substances by a broad demographic of men and women across the country. This led to a resurgence of heroin use, as some users transitioned to using this cheaper street cousin of expensive prescription opioids. As a result, the number of people dying from opioid overdoses soared—increasing nearly four-fold between 1999 and 2014.	”
—Surgeon General of the United States

In March 2016, Massachusetts became the first state to enact legislation to limit the supply of opioid painkillers prescribed by doctors. As of November 2017, 28 states had enacted similar legislation limiting the initial supply of opioid painkillers that can be prescribed by a doctor. Opioid overdose death rates vary across the states, from 3.1 deaths per 100,000 population in Nebraska to 36 deaths per 100,000 population in West Virginia. Hover over the map below to view opioid overdose death rates by state.

Nonprofit health research and consulting institute Alatrum estimated the cost of the opioid epidemic from 2001 to 2017 was $1 trillion. It projected an additional cost of $500 billion by 2020 from opioid misuse, substance use disorders, and premature mortality. These costs included lost wages, healthcare spending, lost tax revenue, and social services.

The U.S. Department of Justice, under Attorney General Jeff Sessions, created a task force in February 2018 to address illegal practices in the prescription drug pipeline, focusing on manufacturers, distributors, doctors, pain management clinics, and pharmacies.

Support and opposition

Support

Those who support bills limiting initial prescriptions of opioid painkillers say that the use of the painkillers is linked to opioid abuse, heroin abuse, and overdoses. They argue that limiting the supply of opioids will curb drug abuse and addiction by preventing individuals with opioid prescriptions from developing a dependence.

In March 2016, the Centers for Disease Control and Prevention (CDC) issued guidelines that recommended physicians limit opioid prescriptions for acute (or short-term) pain to no more than a seven-day supply. The CDC reasoned that opioid use for short-term pain is associated with long-term opioid use "[b]ecause physical dependence on opioids is an expected physiologic response in patients exposed to opioids for more than a few days":

“	Experts noted that more than a few days of exposure to opioids significantly increases hazards, that each day of unnecessary opioid use increases likelihood of physical dependence without adding benefit, and that prescriptions with fewer days’ supply will minimize the number of pills available for unintentional or intentional diversion.	”
—Centers for Disease Control and Prevention

The CDC guidelines stated that for acute pain, a three-day supply of opioids will often be sufficient, and that supplies greater than seven days are rarely needed.

Some politicians have also expressed the intent of the bills as ending what they describe as the overprescription of opioids and encouraging doctors to consider other forms of pain management. Sen. John McCain (R-Ariz.), who in April 2017 introduced a federal bill to limit initial supplies of opioids to seven days, stated, "One of the main causes for the alarming increase in drug overdoses in the United States is the overprescription of highly addictive opioids. ... [T]his legislation is an important step forward in preventing people from getting hooked on these deadly drugs." Kentucky state Rep. Kimberly Moser (R-64th), who sponsored a similar bill in the state legislature, said, "We felt it was important to just set that pause button and have prescribers just stop and think about the appropriateness of what they’re prescribing. Is it medically necessary?"

Opposition

Those who oppose bills limiting initial prescriptions of opioid painkillers say that such bills make it more difficult for patients who use opioids correctly and as prescribed to continue to get the medication they need. They also argue that limiting the supply of prescription opioids leads users to turn to heroin instead. Writing in an op-ed for STAT, physicians Stefan G. Kertesz, MD, and Adam J. Gordon, MD, argued the following:

“	While doing so [discontinuing opioids] could help some, it will destabilize others and likely promote the use of heroin or other drugs. ... We cannot be surprised by a flurry of reports, in the press, social media, and the medical literature describing pain patients entering acute withdrawal, losing function, committing suicide, or dying in jail.	”
—Stefan G. Kertesz, MD, and Adam J. Gordon, MD

Kertesz and Gordon also argued that laws limiting opioid supplies are inhumane for patients with chronic pain and that there is little evidence such laws are effective, stating "[t]here have been no prospective clinical studies to show that discontinuing opioids for currently stable pain patients helps those patients or anyone else." Finally, the article argued that legal limits on opioids would create a black market for the pills.

An article by Richard Taite for the website of Cliffside Malibu, a substance abuse treatment facility, made a similar point about the creation of black market, stating, "[S]tate-based opioid prescription limits are limited to states that have them. Patients abusing opioids will be able to drive across state borders and see a different physician with more lenient prescribing privileges." Taite also argued that individuals subject to opioid prescription limits would be more likely to turn to heroin.

Recent news

The link below is to the most recent stories in a Google news search for the terms United States healthcare. These results are automatically generated from Google. Ballotpedia does not curate or endorse these articles.

Opioid prescription limits and policies by state - Google News

See also

• 

  Healthcare policy by state

• 

  Effect of the Affordable Care Act in the United States

• 

  U.S. Department of Health and Human Services

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