Assessing The Impact of A Restrictive Opioid Prescribing Law in West Virginia

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Sedney, Maryam Khodaverdi, Robin Pollini, Patricia Dekeseredy, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-80600/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 01 Feb, 2021 Read the published version in Substance Abuse Treatment, Prevention, and Policy → Version 1 posted 10 You are reading this latest preprint version Abstract Background: The Opioid Reduction Act (SB 273) took effect in West Virginia in June 2018. This legislation limited ongoing chronic opioid prescriptions to 30 days’ supply, and first-time opioid prescriptions to 7 days’ supply for surgeons and 3 days’ for emergency rooms and dentists. The purpose of this study was to determine the effect of this legislation on reducing opioid prescriptions in West Virginia, with the goal of informing future similar policy efforts. Methods: Data were requested from the state Prescription Drug Monitoring Program (PDMP) including overall number of opioid prescriptions, number of first-time opioid prescriptions, average daily morphine milligram equivalents (MME) and prescription duration (expressed as “day’s supply”) given to adults during the 64 week time periods before and after legislation enactment. Statistical analysis was done utilizing an autoregressive integrated moving average (ARIMA) interrupted time series analysis to assess impact of both legislation announcement and enactment while controlling secular trends and considering autocorrelation trends. Benzodiazepine prescriptions were utilized as a control. Results: Our analysis demonstrates a statistically significant decrease in overall state opioid prescribing as well as average daily MME associated with the date of the legislation’s enactment when considering serial correlation in the time series and accounting for pre-intervention trends. There was no such association found with benzodiazepine prescriptions. Conclusion: Results of the current study suggest that SB 273 was associated with an average 22.1% decrease of overall opioid prescriptions and a small overall decrease of average daily MME relative to the date of legislative implementation in West Virginia. There was, however, no association of the legislation on first-time opioid prescriptions or days’ supply of opioid medication, and all variables were trending downward prior to implementation of SB 273. The control demonstrated no relationship to the law. Other Public Policy Health Economics & Outcomes Research opioids law prescription opioids opiates interrupted time series Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Full Text Supplementary Files AdditionalFileAppendix.docx Cite Share Download PDF Status: Published Journal Publication published 01 Feb, 2021 Read the published version in Substance Abuse Treatment, Prevention, and Policy → Version 1 posted Review # 2 received at journal 26 Oct, 2020 Editorial decision: Major Revision 26 Oct, 2020 Reviewer # 2 agreed at journal 14 Oct, 2020 Review # 1 received at journal 08 Oct, 2020 Editor assigned by journal 22 Sep, 2020 Reviewers invited by journal 22 Sep, 2020 Reviewer # 1 agreed at journal 22 Sep, 2020 Submission checks completed at journal 21 Sep, 2020 Editor invited by journal 21 Sep, 2020 First submitted to journal 18 Sep, 2020 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-80600","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research","associatedPublications":[],"authors":[{"id":2723957,"identity":"33b1adcb-b150-4d7b-bd0c-ed88915382b0","order_by":0,"name":"Cara L. Sedney","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0UlEQVRIiWNgGAWjYJACCSCWM0DwE4jTYky6lsQNRGvh7z988HZBxeH07fyHHzDzth1m4GfPMcCrReJGWrL1jDOHc3fOSDMAa5HseYNfi4EEj5k0UGXuhhs8DMw5Zw4zGNwgYIsB//lv0rz/DqcbnD8D0WJPUAtDDps0b8PhBIMDOUAtFUBbJAj7xdia51i64YYbaQaH/1Sk80iceVaAVwswxB7e5qmxljc4f/jhwxkG1nL87ckb8GqBgmYweQCIeYhRDgJ1xCocBaNgFIyCkQgAa21ERjYzkFwAAAAASUVORK5CYII=","orcid":"https://orcid.org/0000-0003-1290-7083","institution":"West Virginia University School of Medicine","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Cara","middleName":"L.","lastName":"Sedney","suffix":""},{"id":2723958,"identity":"d816d454-31eb-4c76-bb8e-e3dd6ed82fc5","order_by":1,"name":"Maryam Khodaverdi","email":"","orcid":"","institution":"WVCTSI","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Maryam","middleName":"","lastName":"Khodaverdi","suffix":""},{"id":2723959,"identity":"2b594c5b-7022-42f6-86f8-7f8e49ad52b6","order_by":2,"name":"Robin Pollini","email":"","orcid":"","institution":"West Virginia University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Robin","middleName":"","lastName":"Pollini","suffix":""},{"id":2723960,"identity":"8daab405-dbc0-4478-b636-ce732e8926e4","order_by":3,"name":"Patricia Dekeseredy","email":"","orcid":"https://orcid.org/0000-0001-6083-5358","institution":"West Virginia University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Patricia","middleName":"","lastName":"Dekeseredy","suffix":""},{"id":2723961,"identity":"67f88893-b451-4581-9f35-0a590cf7dc6c","order_by":4,"name":"Nathan Wood","email":"","orcid":"","institution":"West Virgina Board of Pharmacy","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Nathan","middleName":"","lastName":"Wood","suffix":""},{"id":2723962,"identity":"af32e9ac-3367-4f34-8b09-81b72aee33f6","order_by":5,"name":"Treah Haggerty","email":"","orcid":"","institution":"West Virginia University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Treah","middleName":"","lastName":"Haggerty","suffix":""}],"badges":[],"createdAt":"2020-09-19 10:31:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-80600/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-80600/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s13011-021-00349-y","type":"published","date":"2021-02-01T15:02:37+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":2667054,"identity":"0b7230b5-b76b-432e-8872-9b0180ca9b74","added_by":"auto","created_at":"2020-09-28 21:02:32","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":110738,"visible":true,"origin":"","legend":"Prescription limitation language in SB 273 (Opioid Reduction Act)","description":"","filename":"Fig1.JPG","url":"https://assets-eu.researchsquare.com/files/rs-80600/v1/Fig1.JPG"},{"id":2667057,"identity":"63510f53-ea8c-41d1-8f27-99397b810397","added_by":"auto","created_at":"2020-09-28 21:02:33","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":142058,"visible":true,"origin":"","legend":"First Time Opioid Prescriptions: Fig. 2a (top) indicates first time opioid prescriptions in the state of WV over time (in weeks). The broken vertical line indicates legislative announcement and solid vertical line indicates the legislative enactment (intervention). Red dotted line indicates fit of the mathematical model. Fig 2b (bottom) isolates the effect of the intervention.","description":"","filename":"Fig2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-80600/v1/Fig2.jpeg"},{"id":2667058,"identity":"48183421-75d8-4607-8192-0a3b8404bc1f","added_by":"auto","created_at":"2020-09-28 21:02:33","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":157494,"visible":true,"origin":"","legend":"Overall Opioid Prescriptions: Fig. 3a (top) indicates overall opioid prescriptions in the state of WV over time (in weeks). The broken vertical line indicates legislative announcement and solid vertical line indicates the legislative enactment (intervention). Red dotted line indicates fit of the mathematical model. Fig 3b (bottom) isolates the effect of the intervention.","description":"","filename":"Fig3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-80600/v1/Fig3.jpeg"},{"id":2667059,"identity":"05afc747-a807-45de-808a-2a4477a0b467","added_by":"auto","created_at":"2020-09-28 21:02:33","extension":"jpeg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":144413,"visible":true,"origin":"","legend":"Average Days’ Supply: Fig. 4a (top) indicates the average days’ supply of opioid prescriptions in the state of WV over time (in weeks). The broken vertical line indicates legislative announcement and solid vertical line indicates the legislative enactment (intervention). Red dotted line indicates fit of the mathematical model. Fig 4b (bottom) isolates the effect of the intervention.","description":"","filename":"Fig4.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-80600/v1/Fig4.jpeg"},{"id":2667060,"identity":"f727517d-7501-436e-88c1-3ef5f2b961c6","added_by":"auto","created_at":"2020-09-28 21:02:34","extension":"jpeg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":157471,"visible":true,"origin":"","legend":"Average Daily Milligram Morphine Equivalents (MME): Fig. 5a (top) indicates the average daily MME of opioid prescriptions in the state of WV over time (in weeks). The broken vertical line indicates legislative announcement and solid vertical line indicates the legislative enactment (intervention). Red dotted line indicates fit of the mathematical model. Fig 5b (bottom) isolates the effect of the intervention.","description":"","filename":"Fig5.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-80600/v1/Fig5.jpeg"},{"id":13536153,"identity":"6c8be3e6-1248-42c5-b38b-5c464cc898d1","added_by":"auto","created_at":"2021-09-17 01:31:19","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":654923,"visible":true,"origin":"","legend":"","description":"","filename":"SATPPmanuscriptfinal.pdf","url":"https://assets-eu.researchsquare.com/files/rs-80600/v1_covered.pdf"},{"id":2667062,"identity":"2765f221-abb6-4fdf-8436-a19b6c07b1d5","added_by":"auto","created_at":"2020-09-28 21:02:40","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":663475,"visible":true,"origin":"","legend":"","description":"","filename":"SATPPmanuscriptfinal.pdf","url":"https://assets-eu.researchsquare.com/files/rs-80600/v1_stamped.pdf"},{"id":2667055,"identity":"3d843121-541e-4b9b-a9da-a9c5b0f919bb","added_by":"auto","created_at":"2020-09-28 21:02:32","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":617154,"visible":true,"origin":"","legend":"","description":"","filename":"SATPPmanuscriptfinal.pdf","url":"https://assets-eu.researchsquare.com/files/rs-80600/v1/SATPPmanuscriptfinal.pdf"},{"id":2667056,"identity":"fc17b9ac-9fc2-40cd-9326-926328e0cc9f","added_by":"auto","created_at":"2020-09-28 21:02:33","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":722854,"visible":true,"origin":"","legend":"","description":"","filename":"AdditionalFileAppendix.docx","url":"https://assets-eu.researchsquare.com/files/rs-80600/v1/AdditionalFileAppendix.docx"}],"financialInterests":"","formattedTitle":"\u003cp\u003eAssessing The Impact of A Restrictive Opioid Prescribing Law in West Virginia\u003c/p\u003e","fulltext":[{"header":"Full Text","content":"\u003cp\u003eThis preprint is available for \u003ca href='/article/rs-80600/latest.pdf' target='_blank'\u003edownload as a PDF\u003c/a\u003e.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"substance-abuse-treatment-prevention-and-policy","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"satp","sideBox":"Learn more about [Substance Abuse Treatment, Prevention, and Policy](http://substanceabusepolicy.biomedcentral.com)","snPcode":"13011","submissionUrl":"https://submission.nature.com/new-submission/13011/3","title":"Substance Abuse Treatment, Prevention, and Policy","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"opioids, law, prescription opioids, opiates, interrupted time series","lastPublishedDoi":"10.21203/rs.3.rs-80600/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-80600/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e\u0026nbsp;The Opioid Reduction Act (SB 273) took effect in West Virginia in June 2018.\u0026nbsp;This legislation limited ongoing chronic opioid prescriptions to 30 days’ supply, and first-time opioid prescriptions to 7 days’ supply for surgeons and 3 days’ for emergency rooms and dentists. The purpose of this study was to determine the effect of this legislation on reducing opioid prescriptions in West Virginia, with the goal of informing future similar policy efforts. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e Data were requested from the state Prescription Drug Monitoring Program (PDMP) including overall number of opioid prescriptions, number of first-time opioid prescriptions, average daily morphine milligram equivalents (MME) and prescription duration (expressed as “day’s supply”) given to adults during the 64 week time periods before and after legislation enactment. Statistical analysis was done utilizing an autoregressive integrated moving average (ARIMA) interrupted time series analysis to assess impact of both legislation announcement and enactment while controlling secular trends and considering autocorrelation trends.\u0026nbsp;Benzodiazepine prescriptions were utilized as a control.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Our analysis demonstrates a statistically significant decrease in overall state opioid prescribing as well as average daily MME associated with the date of the legislation’s enactment when considering serial correlation in the time series and accounting for pre-intervention trends. \u0026nbsp;There was no such association found with benzodiazepine prescriptions.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Results of the current study suggest that SB 273 was associated with an average 22.1% decrease of overall opioid prescriptions and a small overall decrease of average daily MME relative to the date of legislative implementation in West Virginia. There was, however, no association of the legislation on first-time opioid prescriptions or days’ supply of opioid medication, and all variables were trending downward prior to implementation of SB 273. \u0026nbsp;The control demonstrated no relationship to the law.\u003c/p\u003e","manuscriptTitle":"Assessing The Impact of A Restrictive Opioid Prescribing Law in West Virginia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2020-09-28 21:02:02","doi":"10.21203/rs.3.rs-80600/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2020-10-26T12:00:00+00:00","index":2,"fulltext":"Recommendation: Reviewer's comments unavailable due to the journal's policy.\n"},{"type":"decision","content":"Major Revision","date":"2020-10-26T12:00:00+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"","date":"2020-10-14T12:00:00+00:00","index":2,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2020-10-08T12:00:00+00:00","index":1,"fulltext":"Recommendation: Reviewer's comments unavailable due to the journal's policy.\n"},{"type":"editorAssigned","content":"","date":"2020-09-22T12:00:00+00:00","index":"","fulltext":""},{"type":"reviewersInvited","content":"","date":"2020-09-22T12:00:00+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"","date":"2020-09-22T12:00:00+00:00","index":1,"fulltext":""},{"type":"checksComplete","content":"","date":"2020-09-21T12:00:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2020-09-21T12:00:00+00:00","index":"","fulltext":""},{"type":"submitted","content":"","date":"2020-09-18T12:00:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"substance-abuse-treatment-prevention-and-policy","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"satp","sideBox":"Learn more about [Substance Abuse Treatment, Prevention, and Policy](http://substanceabusepolicy.biomedcentral.com)","snPcode":"13011","submissionUrl":"https://submission.nature.com/new-submission/13011/3","title":"Substance Abuse Treatment, Prevention, and Policy","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e0276325-73e1-474e-89d2-d10c59b471f6","owner":[],"postedDate":"September 28th, 2020","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":630209,"name":"Other Public Policy"},{"id":630210,"name":"Health Economics \u0026 Outcomes Research"}],"tags":[],"updatedAt":"2021-02-07T15:03:35+00:00","versionOfRecord":{"articleIdentity":"rs-80600","link":"https://doi.org/10.1186/s13011-021-00349-y","journal":{"identity":"substance-abuse-treatment-prevention-and-policy","isVorOnly":false,"title":"Substance Abuse Treatment, Prevention, and Policy"},"publishedOn":"2021-02-01 15:02:37","publishedOnDateReadable":"February 1st, 2021"},"versionCreatedAt":"2020-09-28 21:02:02","video":"","vorDoi":"10.1186/s13011-021-00349-y","vorDoiUrl":"https://doi.org/10.1186/s13011-021-00349-y","workflowStages":[]},"version":"v1","identity":"rs-80600","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-80600","identity":"rs-80600","version":["v1"]},"buildId":"cBFmMYwuxLRRLfASyISRj","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}