Reduction of Opioid Prescriptions in Maxillofacial Trauma Following North Carolina STOP Act

Abstract

Study Design: Retrospective cohort study Objective: On January 1, 2018, the Strengthen Opioid Misuse Prevention (STOP) Act was implemented to increase oversight over opioid prescriptions in North Carolina. The aim of this study is to evaluate the legislation’s efficacy in reducing opioid prescriptions following facial fracture repair. Methods: A retrospective chart review of patients who sustained maxillofacial fractures and underwent repair from January 1, 2015 through December 31, 2019 at a level 1 trauma center was performed. The North Carolina Controlled Substance Database was used to quantify perioperative opioid prescriptions in morphine milligram equivalents (MME). Average MME per patient was compared between 2 groups, patients who underwent surgery before the NC STOP Act came into effect and patients who underwent treatment after. This comparison was also performed on case type subgroups including surgically treated fractures of the orbit, mandible, midface, and multiple regions. A student’s t-test was used to compare before and after groups in all analyses. Results: Of the 253 patients who met inclusion criteria, 146 were in the before group, and 107 were in the after group. There was a statistically significant, 30.9% decrease in overall average MME prescribed after the NC STOP Act was enacted. A statistically significant decrease was noted in patients who had facial fractures of multiple regions. Conclusion: Since the implementation of the NC STOP Act in 2018, there have been statistically and clinically significant decreases in the amount of opioids prescribed following surgical management of facial fractures.

The 2017 North Carolina STOP Act is Associated With an Accelerated Decrease in Opioid Dispensing: A Statewide Analysis, 2013–2019

“…Our results are consistent with other studies that show a decrease in the number of opioid prescriptions over time and in response to the STOP Act [9][10][11]. In a commercially insured population, Maierhofer and colleagues found that the introduction of the STOP Act was associated with decreases in incident opioid prescriptions, mean daily morphine milli-equivalents, and days' supply, which is consistent with our findings [10].…”

“…Prior studies have suggested that the NC STOP Act has led to reductions in the number of opioid prescriptions [9][10][11]. These prior studies have been limited to only one health system, one type of provider, or were conducted a few months after implementation of the act.…”

The Effect of Antiopioid State Laws on Prescribing Patterns in an Oculoplastic Practice

“…Floor fractures also drove up the average MMEs/month as they composed the majority of procedures in each time period, ranging between 35% and 57%. The MMEs/month for orbital-floor fracture repairs before Texas state policies were enacted were already at or below those prescribed in other states after their respective antiopioid policies went into effect [9,10].…”

“…In 2020, a study at the University of Michigan found that the passage of state opioid legislation correlated with a decreased in the rate of opioid prescribing after oculoplastic and orbital procedures [9]. A similar trend was seen in North Carolina for orbital-floor fracture repairs, albeit in the otolaryngology department [10]. Given these findings, the goal of this study is to determine whether Texas House Bill 2174 and House Bill 3284, as well as the e-prescription requirement, have influenced opioid prescribing practices among ophthalmologists who perform oculoplastic or orbital-trauma surgeries at the University of Texas Medical Branch (UTMB).…”