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January 31, 2019

Opioid Prescribing Limits for Acute Pain: Potential Problems With Design and Implementation

Author Affiliations
  • 1Department of Pediatrics, Child Health Evaluation and Research Center, University of Michigan Medical School, Ann Arbor
  • 2Michigan Opioid Prescribing Engagement Network, Ann Arbor
  • 3Division of Pain Medicine, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor
  • 4Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor
JAMA. 2019;321(7):643-644. doi:10.1001/jama.2019.0010

Recent studies indicate that the amount of opioid medication prescribed for acute pain often exceeds the amount of opioid actually consumed by patients.1,2 Eliminating excessive prescribing of opioids for acute pain could decrease the amount of unused opioids available for diversion and misuse.1,2 Moreover, eliminating excessive prescribing of opioids also could prevent opioid dependence, the risk of which is associated with the amount of opioid initially prescribed.3 Consequently, as of November 2018, a total of 32 states have enacted legislation that limits the duration of opioid prescriptions to patients with acute pain or to patients new to opioids, in most cases to a 7-day supply or less. Several organizations have enacted similar policies, including at least 18 large private health insurers, 1 major retail pharmacy, and the 3 largest pharmacy benefit managers in the United States (eTable in the Supplement). Thus, opioid prescribing limits for acute pain are an increasingly prominent component of the policy response to the US opioid epidemic.4

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