UF research cited, as lawmakers pivot away from enacting federal restrictive opioid policy

Federal legislators removed a provision from the Comprehensive Addiction and Recovery Act, or CARA, 2.0 that would have imposed a national three-day limit on opioid prescribing, after patient advocacy groups cited University of Florida research indicating a similar Florida law has led to declines in opioid use among patients needing the prescription medications.

HB 21 opioids

In December 2020, several senators introduced CARA 2.0 to increase funding authorization levels for the CARA program enacted in 2016 and put in place additional policy reforms to help combat the opioid epidemic. The legislation would have imposed a national three-day limit on opioid prescriptions for patients in acute pain. More than 35 states already impose prescription limits, with Florida having one of the most restrictive laws.

Patient advocates from the National Pain Advocacy Center and other allies argued that that opioid prescribing limits harm those people requiring the medications most. They contend opioid overdoses are more related to illicit substances than prescription medication. In citing the existing evidence, they referred to a 2020 study led by UF College of Pharmacy researchers that overall opioid prescribing declined for patients in a private health plan after a three-day limit was enacted in the Sunshine State.

The UF study, published in the journal JAMA Open Network, found a 2018 Florida law restricting opioid prescriptions for acute pain led to a 16 percent drop in new opioid users immediately after the law was implemented, despite no requirement to limit prescribing in the bill. The number of new users continued to decrease in subsequent months. The law was also associated with an immediate decrease in the use of hydrocodone, the most commonly used Schedule II opioid.

“The intent of the law was to decrease the number of days’ supply of the prescriptions, not limit the decision to prescribe opioids,” said Juan Hincapie-Castillo, Pharm.D., Ph.D., M.S., the study’s lead author and an assistant professor of pharmaceutical outcomes and policy in the UF College of Pharmacy.   “Florida’s law had the unintended consequence of reducing the number of patients that receive any opioid prescription, which could lead to inadequate pain treatment. These medications help pain patients manage conditions that do not respond well to other treatment options. ”

Hincapie-Castillo said the same result could have happened on the national level, had lawmakers enacted a national three-day limit on opioid prescribing.

“I am pleased to hear that our research on the effects of opioid restrictions in Florida was heard by policymakers in U.S. Congress,” Hincapie-Castillo said. “This is a great example of how pharmaceutical research can influence policy and make a positive difference in the lives of patients.”

Hincapie-Castillo serves as a member of the Science and Policy Advisory Council for the National Pain Advocacy Center.