Effects of Washington’s Opioid Prescribing Rules for Chronic, Non-Cancer Pain Management on Opioid Overdose Mortality and Pharmaceutical Opioid Distribution: 1999-2017

Background Since the 1990s, the opioid crisis has affected individuals and communities across the United States. National and statewide comprehensive efforts to address the problem include policies to prevent opioid addiction, identify opioid-addicted individuals, and provide effective treatment. In Washington state, in response to rising prescription opioid-related overdose deaths, the legislature passed the Engrossed Substitute House Bill (ESHB) 2876 “Act Relating to Pain Management” in 2010 for the management of chronic non-cancer pain through prescription opioids. Objective To investigate the possible impacts of ESHB 2876 on opioid overdose deaths (OOD) and prescription opioid distribution at retail levels. Methods We conducted a single-sample interrupted time series analysis to examine impacts of ESHB 2876 on statewide OOD deaths and prescription opioids (hydrocodone and oxycodone) distributed at retail level in Washington State from 1999 to 2017. Segmented Poisson regression model was used for the analysis. Data for OOD of Washington State residents were obtained from the Wide-ranging OnLine Data for Epidemiologic Research (WONDER) system of the Centers for Disease Control and Prevention. Prescription hydrocodone and oxycodone distribution at retail levels were obtained from the Automated Reports and Consolidated Ordering System (ARCOS) system of the Drug Enforcement Administration (DEA). Results Following ESHB 2876 implementation in 2011, opioid overdose mortality in Washington State decreased by 5% each year (95% CI: 4% to 7%), compared to the rates predicted from the mortality trend in the 12 years prior to ESHB 2876. The corresponding decline in the retail level hydrocodone and oxycodone distribution was 12% per year (95% CI: 10% to 15%). However, while the decrease in hydrocodone and oxycodone distribution occurred immediately following the legislation, the mortality trend began to attenuate three years prior to ESHB 2876 implementation. Conclusion Opioid overdose mortality and prescription opioid distribution trends decreased statewide after ESHB 2876 implementation. While our study suggests that ESHB 2876 is an effective intervention in reducing hydrocodone and oxycodone distribution at the retail level, it is not clear if the legislation had an influence in producing the decrease in opioid mortality.