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Evaluation of a state law on opioid-prescribing behaviour and the void affecting codeine-containing antitussive syrup
  1. Warren M. Perry1,
  2. Chris B. Agala2,
  3. Erika M. Agala3
  1. 1Emergency Medicine Department, Emory University, Atlanta, Georgia, USA
  2. 2Anesthesiology Department, University of North Carolina, Chapel Hill, NC, United States
  3. 3Emergency Department, University of North Carolina, Chapel Hill, North Carolina, USA
  1. Correspondence to Dr Warren M. Perry, Emergency Medicine Department, Emory University, Atlanta, GA 30322, USA; warren.m.perrymd{at}


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

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  • Contributors WMP, CBA and EMA all contributed significantly to this research study. CBA and WMP performed the literature review for this study. WMP conceived the idea of the study and its design. With the help of WMP, EMA extracted the data and was an integral part in the construction of the final database using quality control methods. The statistical analysis plan was created by CBA and WMP. CBA primarily executed this analysis. WMP primarily composed the manuscript and takes responsibility for the paper as a whole.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Our study was approved by the University of North Carolina at Chapel Hill Institutional Review Board. Our study approval number is 19–0078.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • 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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