Impact of Laws on Pediatric Opioid Prescriptions


Are prescription cap laws for opioids effective for children and teenagers?

In a push to fight the opioid epidemic, many states have passed opioid prescribing cap laws which limit the dose or duration of an opioid prescription. However, most guidelines on prescriptions only offer guidance for adults. New research1 examined whether those laws have an impact on opioid prescribing for children and teenagers.

Using a difference-in-difference approach to account for the staggered adoption of prescription cap policy law, researchers collected data from the OptumLabs Data Warehouse for data on commercially insured children and adolescents aged 0 to 17 years who had full calendar-year continuous insurance enrollment between 2013 and 2019. Children with a cancer were excluded from the study. Thirty-three states enacted laws capping opioid prescriptions, with all legislating opioid duration; 14 states also specified dosing, with 7 also specifying acceptable dosage.

In total, 482,118 children and adolescents were included in the sample, of whom 10,659 were prescribed at least 1 opioid prescription during the study. In this subcohort, the average number of filled opioid prescriptions was 1.2 per person per year. No statistically significant link was found between any outcome and prescribing cap laws. Following implementation of these laws, there was a −0.001 percentage point decrease in the proportion of children receiving a prescription. Furthermore, percentage decreases of −0.02 in opioid prescriptions for more than 7 days, as well as a −0.01 decrease in prescription with doses over mean morphine milligram equivalents per day following implementation, were noted.

“Guidance on prescribing for this age group may be needed as part of the response to the ongoing opioid crisis,” the researchers concluded, adding that guidance should be targeted to those specialties most likely to prescribe opioids for this age group, such as dentists.


Stone EM, Tormohlen KN, McCourt AD, et al. Association between state opioid prescribing cap laws and receipt of opioid prescriptions among children and adolescents. JAMA Health Forum. 2022;3(8):e222461. doi:10.1001/jamahealthforum.2022.2461

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