How States Are Reducing the Opioid Prescription Drug Crisis within Their Borders

Prescription drugs in a bottles, on the wooden american flag background.

It’s no longer a news story that our nation is struggling with an opioid addiction epidemic. It’s been going on for some time. This is an epidemic that started out with opioid pain relievers, and even though other opioid addictions have cropped up since then, a decent piece of the pie chart that is the American opioid addiction crisis is still comprised of pain reliever addiction.

What is newsworthy, however, is that several states are now refusing to wait any longer for the federal government to pull a rabbit out of the hat and fix the opioid epidemic with a flick of the wrist.

Several states are now taking matters into their own hands by innovating their own ways to address their opioid problems. What are they doing that’s working? How could we implement their successful actions on a nationwide level? Let’s take a look at each strategy and which states are applying it.

Limiting Prescriptions to Reduce the Prevalence of Opioid Pharmaceuticals

Pharmacy taking prescription slip from the customer.

The most logical solution to reducing the threat of prescription opioid addiction in a state is to simply reduce the number of pills in that state, right? Easier said than done.

Opioid prescribing rates vary greatly state to state, even county to county. For example, according to the Centers for Disease Control and Prevention, “In 16% of U.S. counties, enough opioid prescriptions were dispensed for every person to have one. While the overall opioid prescribing rate in 2017 was 58.7 prescriptions per 100 people, some counties had rates that were seven times higher than that.”

But some states are having success in reducing their prescribing rates for opioid painkillers. For example, March 2016 saw Massachusetts become the first state to enact legislation that limited the initial supply of opioid pharmaceuticals that doctors could prescribe. By September of 2018, just two and a half years later, 33 states had followed suit, enacting similar restrictions on opioid prescribing trends.

What these laws did is put a cap on what doctors could prescribe to patients. Doctors now had to be especially selective and careful in their prescribing, as they were only allowed to prescribe so much.

Limiting the Duration and Strength of Prescriptions Reduces the Chances for Addiction

This strategy ties into the one above. Not only have some states been limiting the number of pain relievers that doctors could prescribe, but several of those same states have also been limiting the strength and duration of painkillers that could be utilized in those prescriptions.

For example, in 2017, Maryland and North Carolina joined the ranks of several states which had passed laws limiting the number of days for which a prescription could be written for patients with acute pain. The logic here was that acute pain was a pain phenomenon being heavily overprescribed for.

Acute pain refers to short-term pain, like pain from a broken ankle, a surgery, a sprained wrist, wisdom teeth removal, etc. The laws put heavy restrictions on what kinds of painkillers doctors could prescribe for acute pain and for how long.

For a look at what these laws looked like, Maine was featured in USA Today for having enacted a law which restricted patients to one dose of a 100 morphine milligram-equivalent per day, except in very specific and special circumstances. For a state that had been ravaged by extreme over-prescribing of opioids, this was a huge change for the better.

Using Prescription Drug Monitoring Programs Can Be Effective in Curbing Doctor Shopping

Doctor with a patient, using Prescription Monitoring System from iPad,

Prescription Drug Monitoring Programs, or PDMPs, are effective in helping medical practitioners detect “doctor shoppers,” which are essentially addicts who go from one doctor to the next, seeking opioid pills from each one.

At this time, all U.S. states but one utilize PDMP monitoring programs which log information on which patients have been prescribed what pharmaceutical, in what dosage, and for how long. This is information that is then accessible by primary care providers.

However, for years PDMPs were only used on a voluntary basis. A lot of doctors did not agree with the concept, and so the programs were met with limited efficacy. This is the kind of program that only works well if all doctors get behind it.

If an addict is refused opioids by a doctor who sees his extensive prescription history on the PDMP, all that addict has to do is go to another doctor who does not use the state’s PDMP to get a prescription for more pills.

But a big change occurred a few years ago when Kentucky became the first state to pass legislation that made PDMP use mandatory among all doctors practicing within the state. This set a precedent, and several states have followed suit since then.

Using Non-Pharmaceutical Means to Help Patients with Chronic Pain

Another big push in some states is to make non-pharmacological solutions to pain a more regular practice. Why are opioid painkillers the supposed “gold standard” in pain relief? Because the pharmaceutical corporations and the insurance companies have said so.

Physical therapy

But according to the same USA Today article that covered Maine’s law change, a collaborative group of state attorneys is now pushing health insurance providers to provide coverage for non-pharmacological pain relief.

These types of pain relief could include physical therapy, biofeedback, acupuncture, massage therapy, vitamin and supplement therapy, other methods of holistic and alternative medicine, and a whole battery of other pain relief methods that don’t involve highly addictive, mind-altering, and habit-forming pain reliever drugs.

States Can Make Real Progress against the Pharmaceutical Opioid Epidemic

The only reason why we use painkillers is that they’re what the drug companies make, they’re what the health insurance companies will pay for, and they’re what the doctors tell us to take. But that does not mean that they are the correct solution to our pain.

With widespread use of strategies such as the ones outlined above, we actually stand a real chance at reducing states’ painkiller epidemics. The key now lies in getting every state to start implementing similar policies.


Reviewed by Claire Pinelli, ICAADC, LADC, CCS, RAS, MCAP



After working in addiction treatment for several years, Ren now travels the country, studying drug trends and writing about addiction in our society. Ren is focused on using his skill as an author and counselor to promote recovery and effective solutions to the drug crisis. Connect with Ren on LinkedIn.