Journal of the National Cancer Institute · 2026
Opioid limiting law and opioid prescriptions among Medicaid-enrolled survivors of childhood cancer.
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Hu Xin, Klosky James L, Srivastava Deo Kumar, Zhang Zhanji, Brinkman Tara M, Krull Kevin, Nathan Paul C, Snyder Claire, Armstrong Gregory T, Nolan Vikki, Yasui Yutaka, Castellino Sharon M, Ji Xu
Аннотация
BACKGROUND: Many U.S. states have enacted opioid-limiting laws to curb the opioid epidemic, often capping opioid prescriptions at seven days. How these laws affect opioid prescribing among long-term survivors of childhood cancer remains unclear.
METHODS: Using Medicaid claims linked to the Childhood Cancer Survivor Study, we identified childhood cancer survivors aged 18-64 years continuously enrolled in Medicaid ≥1 year during 2009-2019. Primary outcomes were any opioid prescription fill and opioid prescription with >7 days' supply. Secondary outcomes included total number of opioid prescriptions, total days of supply, and mean morphine milligram equivalents per supply day. Difference-in-differences models assessed associations between opioid-limiting law implementation and outcomes, adjusting for sociodemographic and clinical characteristics.
RESULTS: We identified 2,351 survivors (57.0% female, 43.9% aged 18-29 years, 10.2% non-Hispanic Black, 9.7% Hispanic), with 15,323 person-years. Overall, 20.5% filled any opioid prescription, and 9.4% filled prescriptions with >7 days' supply. Opioid-limiting laws were associated with 1.77 percentage points (ppt; p=0.047) reduced likelihood of filling any opioid prescription with >7 days' supply. Associations with other outcomes were not statistically significant. In subgroup analyses, survivors with second cancer experienced statistically significant declines in any opioid prescriptions (-6.96 ppt, p=0.034), prescriptions with >7 days' supply (-7.79 ppts, p=0.001), total number of prescriptions (-0.42, p=0.019), and total days of supply (-7.40 days, p=0.003) following law implementation.
CONCLUSIONS: While opioid-limiting laws were not associated with meaningful reductions in opioid prescribing among Medicaid-enrolled adult survivors of childhood cancer overall, notable declines were observed among subgroups with potentially higher pain care needs.
METHODS: Using Medicaid claims linked to the Childhood Cancer Survivor Study, we identified childhood cancer survivors aged 18-64 years continuously enrolled in Medicaid ≥1 year during 2009-2019. Primary outcomes were any opioid prescription fill and opioid prescription with >7 days' supply. Secondary outcomes included total number of opioid prescriptions, total days of supply, and mean morphine milligram equivalents per supply day. Difference-in-differences models assessed associations between opioid-limiting law implementation and outcomes, adjusting for sociodemographic and clinical characteristics.
RESULTS: We identified 2,351 survivors (57.0% female, 43.9% aged 18-29 years, 10.2% non-Hispanic Black, 9.7% Hispanic), with 15,323 person-years. Overall, 20.5% filled any opioid prescription, and 9.4% filled prescriptions with >7 days' supply. Opioid-limiting laws were associated with 1.77 percentage points (ppt; p=0.047) reduced likelihood of filling any opioid prescription with >7 days' supply. Associations with other outcomes were not statistically significant. In subgroup analyses, survivors with second cancer experienced statistically significant declines in any opioid prescriptions (-6.96 ppt, p=0.034), prescriptions with >7 days' supply (-7.79 ppts, p=0.001), total number of prescriptions (-0.42, p=0.019), and total days of supply (-7.40 days, p=0.003) following law implementation.
CONCLUSIONS: While opioid-limiting laws were not associated with meaningful reductions in opioid prescribing among Medicaid-enrolled adult survivors of childhood cancer overall, notable declines were observed among subgroups with potentially higher pain care needs.