Assessing Opioid Prescribing Patterns After a Policy Change from 2014 to 2023 in the United States: A Literature Review

Abstract

Introduction: On October 6, 2014, the Drug Enforcement Administration (DEA) changed the schedule of hydrocodone combination products from a Schedule III to a Schedule II drug to reduce misuse as a result of the opioid crisis. Despite the strict regulations imposed, there are still overdoses, deaths, and misuse connected to opioids impacting states after laws have been implemented. Objective: This literature review aimed to characterize and describe the selected outcomes after a state or federal opioid policy change on opioid prescribing patterns of opioids in the United States. Methods: To achieve the objective, a MEDLINE PubMed search was performed for peer-reviewed articles published between October 2014 to October 2023, using the search strategy developed. Abstrackr was used to screen the titles and abstracts before the full-text review stage. Observed changes in opioid prescribing were assessed by morphine milligram equivalent (MME), number of opioid prescriptions, day supply of opioid prescriptions, and quantity of opioid prescriptions. Results: After title and abstract screening, 73 articles were eligible for full-text review. After the full-text review, 17 articles met the inclusion criteria for this literature review. MME was the most frequent outcome and was mentioned 16 times throughout the articles. Of the articles that analyzed changes in opioid prescribing following the implementation, ten observed a decrease, one identified no difference, and six had mixed results for the outcomes in the articles. Florida House Bill (HB) 21 was examined five times throughout the studies. Discussion: While the reduction in the outcomes after a policy change demonstrates progress in curbing misuse, the mixed results across different provider types indicates the need for more targeted interventions. The frequent mention of Florida's HB 21 reflects the significance of state-specific legislation in shaping opioid prescribing trends. This literature review highlights the complexity of opioid legislation and its varied impact on prescribing practices. These findings offer valuable insights for policymakers and healthcare stakeholders as they continue to refine strategies to combat the opioid epidemic.