What State Opioid Laws Can Teach Us About Provider Behaviors

I prefer market innovation to legislation and competition to regulation. Why? Because self-motivation is a force more powerful that anything you can ever write into law or codify in a set of rules. What you’re self-motivated to do — good or evil — is another story.

A recent study in the Annals of Internal Medicine demonstrates how that theory plays out in healthcare and shows how even the most well-intentioned state laws can have little effect on provider and patient behavior. You can download the study here.

Researchers from Johns Hopkins, the University of Michigan and Cornell wanted to know if state laws designed to curb overprescribing of opioids by providers to patients worked. The short answer is no.

Here are the study details. The researchers looked at prescribing patterns in 13 states that passed laws between 2010 and 2017 to help control opioid use. The state laws did things like limit the number of prescriptions, limit the size of prescriptions, require prescribers to enroll in the state’s prescription drug monitoring program and require prescribers to check the program before they prescribed an opioid.

The researchers then looked at how those laws affected the number of opioid prescriptions received by non-cancer patients two years after each law took effect. The pool was about two million commercially insured adults age 18 or older suffering from chronic pain conditions like back pain, arthritis, headaches, fibromyalgia and/or neuropathic pain.

According to the researchers, the laws had a “non-statistically significant” impact on the percentage of patients receiving any opioid prescription, the percentage of patients receiving guideline-recommended non-opioid alternative pain killers or the average daily or monthly supply of opioids per patient.

“We did not find an association between state opioid prescribing laws and receipt of opioid prescriptions or guideline-concordant nonopioid pain treatments among commercially insured adults,” the researchers concluded.

And the big question is why?

The researchers suggested that the answer is people, or, as I said in the lede, self-motivation.

“The findings suggest that the decreasing volume of opioid prescribing in the United States may be driven more by shifting clinical guidelines, professional norms, or other factors than by these state laws,” they said.

You can’t make providers do the right things through legislation and regulation. Like all businesses, you have to incent them to do the right things, so they are self-motivated to do the right things. If you want safer care, pay for safer care. If you want better outcomes, pay for better outcomes.

It’s really not that complicated.

Thanks for reading.