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Michigan OPEN


OPEN examines data, clinical practices and strategies to support better pain management, opioid stewardship, policy, treatment and care.

The Opioid Epidemic

Upp, L. A., Waljee, J. F. Published online April 2020. DOI:
  • Opioid-related morbidity and mortality have dramatically increased in the United States over the last several decades.
  • Opioid prescribing after surgery has often been in excess, in part owing to the absence of clear prescribing guidelines based on patient-reported pain and opioid-related outcomes.
  • Disposal of excess pills after surgery remains low, and unused opioid pills are an important contributor to the opioid epidemic owing to diversion and misuse.

Association of State Opioid Prescription Duration Limits With Changes in Opioid Prescribing for Medicare Beneficiaries

Cramer JD, Gunaseelan V, Hu HM, Bicket MC, Waljee JF, Brenner MJ. Association of State Opioid Prescription Duration Limits With Changes in Opioid Prescribing for Medicare Beneficiaries. Journal of the American Medical Association Internal Medicine. Published online 9 August 2021. DOI: 10.1001/jamainternmed.2021.4281
  • Between March 2016 and July 2018, 23 states implemented legislation limiting the duration of initial opioid prescriptions to a maximum of 7 days (17 states limited to 7 days or less, 2 states to 5 days or less, and 4 states to 3 days or less).
  • State laws limiting opioid prescriptions to 7 day or less were associated with a reduction in opioid prescribing by 1.7 days per enrollee.
  • The state legislation on opioid prescribing primarily targets initial opioid prescriptions provided for acute pain, and we observed decreases that were most pronounced among surgeons and dentists.

Association of State Opioid Duration Limits with Postoperative Opioid Prescribing

Agarwal S, Bryan JD, Hu HM, et al. Association of State Opioid Duration Limits With Postoperative Opioid Prescribing. JAMA Netw Open. 2019;2(12):e1918361. Published 2019 Dec 2. doi:10.1001/jamanetworkopen.2019.18361
  • In Massachusetts, the implementation of 7-day limits on initial opioid prescriptions for acute pain was associated with a decrease in prescription size (−38 OMEs) and additional reduction of 1.5 OMEs per month. The implementation was also associated with an average decrease of 0.4 days supplied and the proportion of prescriptions exceeding a 7-day supply (−5.9 percentage points).
  • In contrast, the 7-day limit implementation in Connecticut was not associated with significant changes in opioid prescription.