The association of opioid limiting laws with opioid prescriptions among Medicaid-enrolled survivors of childhood cancer

Many U.S. states have enacted opioid-limiting laws to curb the opioid epidemic, often capping opioid prescriptions at seven days. A cohort study using Medicaid claims linked to the Childhood Cancer Survivor Study investigated how these laws affect opioid prescribing among long-term survivors of childhood cancer. The authors identified childhood cancer survivors aged 18-64 years continuously enrolled in Medicaid for at least one year during 2009-2019. Primary outcomes were any opioid prescription fill and opioid prescription with more than 7 days’ supply. Among 2351 survivors (57.0% female; 43.9% aged 18-29 years; 10.2% non-Hispanic Black and 9.7% Hispanic) with 15,323 person-years, 20.5% filled any opioid prescription, and 9.4% filled prescriptions with more than 7 days’ supply. Opioid-limiting laws were associated with 1.77 percentage points (ppt) reduced likelihood of filling any opioid prescription with more than 7 days’ supply (p=0.047). In subgroup analyses, survivors with second cancer experienced statistically significant declines in any opioid prescriptions (-6.99 ppt; p=0.034), prescriptions with longer than 7 days’ supply (-7.70 ppt; p=0.001), total number of prescriptions (-0.42; p=0.0019), and total days of supply (-7.40; p=0.003) following law implementation. The authors conclude that while opioid-limiting laws were not associated with meaningful reductions in opioid prescribing among Medicaid-enrolled adult survivors of childhood cancer overall, notable declines were observed among subgroups with potentially higher pain care needs.