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Evaluation of a state law on opioid-prescribing behaviour and the void affecting codeine-containing antitussive syrup


Background Government opioid policies—such as the North Carolina Strengthen Opioid Misuse Prevention (STOP) Act—have aided in lowering the days’ supply of opioid prescriptions. However, what effect do these laws have on codeine-containing antitussive syrup? We aimed to assess the effect of the North Carolina STOP Act on ED opioid prescriptions written for >5 days for acute pain/non-pain diagnoses and whether it had an effect on the prescribing of codeine-containing antitussive syrup.

Methods A retrospective study of two emergency departments, with an average annual census of 70 000 and 22 000 patients, from January to August of 2017 and 2018. We applied logistic regression techniques to calculate the odds of an opioid prescription for >5 days. Opioid medication categories were formed to determine relational proportions. Two-tailed z-tests were used to test the difference in proportions.

Results Our study included 5366 verifiable opioid prescriptions. The percentage of an opioid prescription for >5 days decreased by 3.3% (95% CI −1.8% to −4.7%, p<0.05) after the North Carolina STOP Act (9.8% to 6.5%; 95% CI 5.5% to 7.5%, p<0.05). There was no statistically significant change in the prescribing of codeine syrup for >5 days pre-STOP and post- STOP Act, respectively (91.5% and 90.4%; difference=−1.1%, p=0.83).

Conclusion The North Carolina STOP Act was associated with a reduction in the overall percentage of opioid prescriptions for >5 days for acute pain/non-pain diagnoses. However, there was no statistically significant effect on the prescribing of codeine-containing antitussive syrup.

  • law
  • guidelines
  • pain management
  • drug abuse

Data availability statement

No data are available. Data contains patients' history of present illness and are not available to anyone outside of the respective healthcare system.

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