An Examination of Opioid Prescribing Policy and Clinical Practice in the Context of the United States Opioid Crisis

Abstract

In 2017, the United States government declared that the opioid epidemic was a public health emergency. Among responses to address the epidemic, the Centers for Disease Control and Prevention released a set of opioid prescribing guidelines for primary care clinicians. Since their release, federal agencies and experts have been interested and concerned about their application in policy and clinical practice. This dissertation examines how some of these federal recommendations were implemented in clinic practice and state law, as well as the effects of related prescribing laws. This dissertation includes three studies 1) a qualitative analysis of clinician and patient discussions about opioid-related risks, benefits, and treatment goals, 2) a policy surveillance study of state tapering laws and their consistency with the CDC guideline’s opioid tapering recommendations, and 3) an empirical study of the effects of morphine milligram equivalent daily dose laws and acute opioid prescribing laws on pain medication prescribing for patients with Medicaid. Overall, this dissertation attempts to understand the translation of national opioid prescribing guidelines into policy and their effects on healthcare delivery.