Examining Statewide Opioid Prescribing Limits and Prescription Drug Monitoring Program Mandates: Provider Compliance and Patient Outcomes

Introduction In response to the opioid crisis, Colorado enacted Senate Bill 18-022, which limits initial opioid prescriptions to 7 days for opioid-naïve patients and mandates prescription drug monitoring program review before a second prescription. This study evaluates provider adherence to these mandates and associated patient outcomes. Methods A retrospective cohort study was conducted using linked electronic health record and prescription drug monitoring program data from a large academic-affiliated healthcare system in Colorado. Adult opioid-naïve patients (aged 18–89 years) who received an initial opioid prescription between May 2018 and May 2019 were included. Provider adherence to the 7-day prescribing limit for the first and second prescriptions and prescription drug monitoring program review mandate with the second opioid prescription were assessed. Patient outcomes included chronic opioid use, aberrant opioid use, and healthcare utilization within 6 months after the prescription. Results Among 35,461 opioid-naïve patients prescribed an opioid, 78.5% received an initial prescription consistent with the 7-day statutory limit. Of the 9,423 patients with a second opioid prescription, 58.4% received a 7-day supply or less, and 13.1% had a documented prescription drug monitoring program review. Prescriptions exceeding 7 days were significantly associated with increased chronic opioid use (31.9% vs 0.2%), aberrant use (4.0% vs 2.1%), and higher healthcare utilization (mean 5.44 vs 1.95 visits). Prescription drug monitoring program review was not associated with reduced chronic opioid use or healthcare visits and was more common among patients with worse outcomes, suggesting potential confounding by patient complexity. Conclusions Providers largely adhered to the 7-day opioid prescribing limit, which was associated with improved patient outcomes. However, mandated prescription drug monitoring program checks were infrequent and not associated with reduced risk, highlighting the need to reassess the effectiveness of prescription drug monitoring program–related policies.