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Opioids are a class of drugs that are derived from the opium poppy (or, in the example of pharmaceuticals, made synthetically) and demark to nerve cells, inhibiting pain signals. Vicodin, OxyContin, and morphine are all examples of opioids. On November 1, 2011, the Centers for Disease Control and Prevention (CDC) issued a press release stating that overdoses from prescription opioid painkillers had reached epidemic levels.[1]

HIGHLIGHTS

  • On March 31, 2021, North Dakota Gov. Doug Burgum (R) signed Firm bill No. 1139 into law, amending the Northward Dakota Century Code to prohibit organizations from paying for opioid therapy exceeding 90 morphine milligram equivalents, or more than a seven-mean solar day supply of opioid medication in the commencement 30 days of opioid therapy.[ii]

  • In March 2016, Massachusetts became the start state to enact legislation to limit the initial supply of opioid painkillers prescribed by doctors.

  • Every bit of Jan 2022, 38 states had implemented policies or guidelines setting limits on the supply of opioids that tin be prescribed by doctors. The opioid limits in five of those states but utilize to Medicaid recipients. Ii of those states have no set pill or day limit for opioid prescriptions only crave doctors to prescribe the everyman effective dose.[3] [four] [5]

  • Supporters of opioid limits such as the Centers for Disease Control and Prevention argue that "prescriptions with fewer days' supply will minimize the number of pills available for unintentional or intentional diversion." Opponents of the laws such equally physicians Stefan G. Kertesz, Doc, and Adam J. Gordon, Doc argue that while the laws "could help some, it volition destabilize others and likely promote the use of heroin or other drugs."[6] [7]

    • Of the 38 states with opioid limits, 17 were controlled by Republican trifectas when the limits were adopted, five were controlled by Democratic trifectas, and 16 were under divided government. Twenty-five states set opioid prescription limits through legislation, two states prepare opioid limits through an executive gild, and 11 states authorized another organization to set limits or guidelines. For the most up-to-date information on state government trifectas, see here.

    State policies

    The section below is current equally of April four, 2022. If we are missing whatsoever policies, please e-mail Ballotpedia'due south Editor.

    Alabama

    • Current limit: Seven-day limit (adults) and v-day limit (minors) (Medicaid recipients simply, excluding hospice, long-term care and cancer patients)
    • Policy: The Alabama Medicaid Agency implemented a policy on November 1, 2018, which limited short-acting prescription opioids for patients without an opioid claim history in the by 180 days. The policy established a maximum supply of 7 days for adults and v days for children, with a l morphine milligram equivalent (MME) limit per 24-hour interval. The AMA implemented a policy on Baronial 1, 2019, to decrease the daily cumulative MME limit by fifty MME every four months until it reached 90 MME per day (the Middle for Disease Control and Prevention recommendation).[8]

    Alaska

    • Current limit: Seven-solar day initial limit (adults) and seven-twenty-four hours limit (minors)
    • Policy: Gov. Bill Walker (I) signed House Beak 159 into police force on July 25, 2017. The legislation limits the commencement fill prescription of opioids to a 7 day supply. Prescriptions can exceed vii days if a doc provides a valid reason for why a longer prescription is needed. Valid reasons for an extension include logistical or travel barriers and if a patient needs more pills to manage chronic pain. The legislation too requires opioid prescription training for medical professionals.[ix] [ten]
    • At the nib'southward signing ceremony, Gov. Walker made the post-obit statement: "I introduced this legislation as a part of our multi-pronged effort to fight the opioid epidemic facing Alaska, and I'chiliad incredibly pleased to exist able to sign information technology today. One death resulting from opioid abuse or misuse is also many, and nosotros must tackle this issue head-on equally Alaskans. HB 159 is an example of healthcare providers, legislators, and Alaskans pulling together to build a safer country as a customs. I thank Rep. Spohnholz, Sen. Micciche, Chief Medical Officer Dr. Jay Butler, and countless others for all of the work put into this legislation. It is my sincere hope that lives volition be changed as a upshot of it."[xi]

    Arizona

    • Electric current limit: 5-day initial limit
    • First policy: Gov. Doug Ducey (R) signed an executive order on Oct 24, 2016, that fix opioid prescription limits for anyone insured under the state'south Medicaid program or the state'due south employee insurance plan. The order limits the first fill up prescription of opioids for adults to seven days. No opioid prescriptions are permitted for children unless they take cancer, a chronic disease, or endure a traumatic injury.[12] "This is a preventive step, and one we hope that employers and insurance companies will follow our lead to address the scourge of addiction on the front," said Gov. Ducey on the executive order.[12]
    • 2nd policy: On Jan 26, 2018, Gov. Doug Ducey (R) signed Senate Bill 1001, known as the Arizona Opioid Epidemic Human action. The legislation limited the outset fill prescription of adults to five days and aligned state dosage levels with federal guidelines; invested $x meg to assist in improving access to handling; expanded police force enforcement's access to Naloxone, a drug used to contrary overdoses; enacted standing medical education for opioid prescribers; and required e-prescribing, amid other provisions. The legislation passed unanimously in the Arizona Land Legislature.[13]

    Colorado

    • Current limit: Seven-24-hour interval initial limit (long-term care excluded)
    • Start policy: Colorado's Department of Wellness Care Policy and Financing announced a new policy on July 10, 2017, to reduce opioid prescriptions in the land's Medicaid program. The policy was rolled out in ii phases. The offset phase went into effect on August 1, 2017, and limits the supply of opioids a Medicaid recipient tin receive if they did not have an opioid prescription in the past 12 months. The policy limits the first fill prescription of opioids to a seven day supply. Patients can get 2 more seven-day prescriptions, but a fourth prescription would have to be approved by the section. Medicaid recipients that already had an opioid prescription before the new policy volition all the same exist allowed up to a xxx-twenty-four hours prescription. The second phase went into effect on October one, 2017, and reduced the morphine milligram equivalents (MME) from Medicaid patients from 300 MME per day to 250 MME per day. The new MME limit does not apply to patients existence treated for cancer or in palliative or hospice care.[xiv] [15]
    • 2d policy: On May 21, 2018, Gov. John Hickenlooper (D) signed Senate Pecker 22 into police force. The neb implemented a seven-mean solar day initial limit on opioid prescriptions, with prescribers immune to write some other 7-solar day prescription if they consider it necessary. The bill included exemptions for patients experiencing chronic pain, cancer patients, patients under hospice care, and patients experiencing postal service-surgical hurting expected to last longer than 14 days.[xvi] [17]

    Connecticut

    • Current limit: Seven-day initial limit (adults) and five-day limit (minors)
    • Kickoff policy: Gov. Dan Malloy (D) signed House Nib 5053 into law on May 27, 2016. This legislation limits the first fill prescription of opioids to vii days. Prescriptions tin can exceed vii days if a doctor determines that the acute or chronic hurting status requires it. The legislative also limited opioid prescriptions for minors to seven days.[xviii]
    • Second policy: Gov. Dan Malloy (D) signed House Beak 7052 into constabulary on June xxx, 2017. This pecker reduced opioid prescriptions for minors from vii days to v days.[xix] At the bill's signing anniversary, Gov. Malloy fabricated the following statement: "Opioid habit and prescription drug abuse is a disease that is impacting near every community and people of every background. It is a complex crisis that does not have ane root crusade, nor does it accept simple solution, but nosotros demand to exercise everything in our ability to care for and prevent information technology. Our work on this front will not be finished until our communities and our families are no longer struggling with the grave costs of this illness."[19]

    Delaware

    • Current limit: Seven-day initial limit (adults) and vii-day limit (minors)
    • Policy: Delaware's Division of Professional Regulation gear up limits on opioid prescriptions on Apr 1, 2017. The new rules limit the first fill prescription of opioids to vii days for adults. The rules likewise limit opioid prescriptions for minors to seven days. Prescriptions can exceed seven days if a md determines that the patient requires it. If the doctor deems that a larger supply is necessary, the patient must undergo a physical exam, be educated about the dangers of opioid corruption, and the physician must examine the patients prescription history.[20]
    • Secretary of State Jeff Bullock (D), whose department regulates controlled substances, made the following statement: "These regulations can salve lives past helping to curb the abuse of opiates in our state. Delaware's prescription rate for certain opiates is amongst the highest in the nation, according to the Centers for Disease Control, and nosotros know what many users of heroin tell us: Their drug abuse can be traced back to a fourth dimension when they were prescribed opiates for an injury or some other valid medical need. With these regulations, we are supporting the efforts of those seeking to break that cycle – including doctors, pharmacists, public health workers and our law enforcement agencies."[xx]

    Florida

    • Current limit: Three-twenty-four hour period limit (acute pain)
    • Policy: Gov. Rick Scott (R) signed opioid legislation that places a three-day limit on prescribed opioids for acute pain, with some exceptions for a vii-day prescription. The law requires healthcare providers to verify a patient's medication history past checking a statewide database of controlled substance prescriptions and mandates that doctors participate in continuing education courses for prescribing opioids. It increases penalties for providers that prescribe opioids through fraudulent or deceptive methods and establishes measures to limit unlicensed hurting management clinics. Gov. Scott also noted that the state'south fiscal twelvemonth 2019 upkeep included $65 million to gainsay the opioid crisis.[21]

    Hawaii

    • Current limit: Seven-twenty-four hour period initial limit
    • Policy: Gov. David Ige (D) signed Senate Bill 505 into law on July 3, 2017. This legislation limits initial opioid and benzodiazepines prescriptions to no longer than vii sequent days. Prescriptions can exceed seven days under sure circumstances, such as treatment for cancer, someone in palliative care, and post-operative intendance.[22] [23]

    Indiana

    • Current limit: Seven-day initial limit (adults) and seven-day limit (minors)
    • Policy: Gov. Eric Holcomb (R) signed Senate Bill 226 into law on April 26, 2017. The law went into effect on July 1, 2017. Senate Bill 226 limits the first fill up prescription of opioids to 7 days for adults. The police force also limits opioid prescriptions for minors to seven days. Prescriptions can exceed vii days under certain circumstances, such equally the doctor determines that the patient requires it and if the patient is in palliative intendance.[24]
    • At the nib's signing anniversary, Gov. Holcomb made the post-obit argument: "The opioid crunch is negatively impacting the lives of Hoosiers, their families, our communities—fifty-fifty our economy. I commend lawmakers for supporting my initiatives and delivering a bundle of legislation that provides a holistic framework for united states of america to attack this epidemic."[25]

    Iowa

    • Policy: Gov. Kim Reynolds (R) signed HB 2377 on May fourteen, 2018. The law requires doctors to register for and utilise prescription monitoring program, establishes criteria for recognizing patients at loftier risk for abuse and habit, requires electronic prescribing, and allows licensing boards to evaluated penalties for healthcare providers who overprescribe.[26]

    Kentucky

    • Current limit: Three-twenty-four hour period initial limit
    • Policy: Gov. Matt Bevin (R) signed Firm Bill 333 into police force on April x, 2017. The police force officially went into outcome on June 29, 2017. The constabulary limits initial opioid prescriptions for acute pain to three days. Prescriptions tin can exceed iii days under certain circumstances. Patients tin can receive a larger supply if the medical provider determines that its necessary to treat chronic hurting, cancer-related pain, and pain after surgery.[27] [28]

    Louisiana

    • Electric current limit: 7-day initial limit (adults) and seven-mean solar day limit (minors)
    • Policy: Gov. John Bel Edwards (D) signed House Nib 192 into police on June 12, 2017. The law officially went into issue on August ane, 2017. The law limits initial opioid prescriptions for acute pain to seven days. The police force does non apply to patients with chronic hurting, cancer, or patients receiving hospice care.[29] [22]
    • Gov. Bel Edwards made the following statement afterwards the bill passed the Louisiana State Legislature: "Given the increasing abuse of opioids in our state and nation, these bills could save the lives of those who are at take a chance of becoming addicted and consequently prevent their family unit and friends from the heartache that comes from seeing their loved-ones endure. I am appreciative of the bipartisan piece of work of Representatives Moreno and Talbot for working with our country's health care providers and each other on behalf of the people of Louisiana. Their concern for our citizens likewise as those lawmakers who also supported the bills proves that when information technology comes to doing what'due south correct, our focus should be and can exist on our people rather than politics."[xxx]

    Maine

    • Current limit: 100 morphine milligram equivalents (MME) per twenty-four hours, seven-days (acute pain), and xxx days (chronic pain)
    • First policy: Gov. Paul LePage (R) signed L.D. 1646 into law on April 19, 2016. The law prepare a seven-day limit on opioid prescriptions for acute pain and a thirty-twenty-four hour period limit on opioid prescriptions for chronic pain. Nether the new law, patients may also non exceed 100 MME per mean solar day. In some cases, patients tin can exceed their prescription limits and MME limits for cases such as cancer hurting, hospice and palliative care, and treatment for a substance abuse disorder.[31]
    • Second policy: Gov. Paul LePage (R) signed LD 1031 on June 16, 2017, which clarified the exceptions to the MME limit in L.D. 1646. The police force clarified to medical professionals that patients could receive more than 100 MME per 24-hour interval if they suffered from chronic pain, cancer hurting, were nether hospice and palliative care, or were in treatment for a substance abuse disorder.[32]

    Maryland

    • Current limit: No set up pill or day limit. Must prescribe lowest effective dose.
    • Policy: Gov. Larry Hogan (R) signed Firm Pecker 1432 on May 25, 2017. The legislation requires medical professionals to prescribe the lowest constructive dose of an opioid.
    • At the bill'due south signing ceremony, Gov. Hogan made the following statement: "These disquisitional initiatives volition assistance us go along to lead the accuse confronting Maryland'due south heroin and opioid crisis in our country. Our administration remains committed to treating this crisis like the emergency that it is, and I thank the legislature for working with us to provide additional tools to relieve the lives of Marylanders – earlier it's also late."[33]

    Massachusetts

    • Electric current limit: Seven-24-hour interval initial limit (adults) and seven-day limit (minors)
    • Policy: Gov. Charlie Baker (R) signed House Neb 4056 into police on March xiv, 2016. The police limits initial opioid prescriptions to seven days for adults. The police force too limits opioid prescriptions for minors to seven days. Prescriptions can exceed seven days under sure circumstances, such cancer pain, chronic pain, and for palliative care.[34]
    • At the nib's signing ceremony, Gov. Baker made the following argument: "Today, the Republic stands in solidarity to fight the opioid and heroin epidemic that continues to plague our state and brunt countless families and individuals. I am proud to sign this legislation marking a remarkable statewide effort to strengthen prescribing laws and increase education for students and doctors. While at that place is still much work to be done, our administration is thankful for the legislature'southward endeavor to pass this bill and looks forward to working with the Chaser General and our mayors to bend the trend and back up those who have fallen victim to this horrific public wellness epidemic."[35]

    Michigan

    • Current limit: Vii-day limit for astute pain
    • Policy: In Dec 2017, Lt. Gov. Brian Calley (R) signed a package of 10 bills related to opioids. The bills required parentel consent before prescribing opioids to a minor and established sanctions for prescribers who fail to inform minors of the risks of opioid abuse; required a doctor to have a prescriber-patient relationship with the patient and conduct follow-up intendance later on prescribing opioids; and limited prescriptions for acute hurting to seven days.[36]

    Minnesota

    • Electric current limit: Four-24-hour interval limit (acute dental or ophthalmic pain)
    • Policy: Gov. Mark Dayton (D) signed SF 2a into law on May thirty, 2017. The legislation limits opioid presciptions for astute dental or refractive surgery hurting to four-days.[37] [38]

    Missouri

    • Electric current limit: Seven-twenty-four hours initial limit (Medicaid recipients only)
    • Policy: Missouri's Medicaid program adopted a new policy on March 27, 2017, to reduce opioid prescriptions in the state's Medicaid program. The new initiative limits initial opioid prescriptions to seven days.[39] [forty]
    • On July 11, 2019, Missouri passed SB 514, requiring dentists to document and explain prescriptions of extended-release opioids or doses greater than 50 morphine milligram equivalents for the handling of acute pain.[41]

    Nebraska

    • Electric current limit: 150 tablets per thirty-days (Medicaid recipients only), vii-day limit (patients under the age of nineteen)
    • First policy: Nebraska's Medicaid program adopted a new policy on October ane, 2016, to reduce opioid prescriptions in the state'southward Medicaid program. The land will limit Medicaid recipients to 150 doses of curt-acting opioids in thirty days.[42]
    • After the opioid prescription changes were announced, Gov. Pete Ricketts (R) fabricated the following statement: "The consequences of opioid abuse tin can be devastating, as national statistics demonstrate. I applaud DHHS for taking decisive action on this pervasive trouble to ensure that our citizens stay healthy. DHHS's collaborative efforts volition benefit many Nebraskans, and I hope that anyone suffering from dependency to these drugs will seek out assistance from an opioid addiction treatment program."[42]
    • 2d policy: On April 4, 2018, Gov. Pete Ricketts (R) signed LB 931, which limited opioid prescriptions to seven days for patients under the age of 19, directed healthcare providers to discuss the risks of habit with patients receiving opioids, and required photo identification for patients receiving dispensed opioids. The Nebraska Land Legislature unanimously passed the legislation.[43]

    Nevada

    • Electric current limit: 90 morphine milligram equivalents (MME) per day and 14-day initial limit (acute pain)
    • Policy: Gov. Brian Sandoval (R) signed Assembly Bill 474 into law on June xvi, 2017. The law set a 14-twenty-four hours initial limit on opioid prescriptions for astute pain. Under the new constabulary, patients may likewise not exceed 90 MME per twenty-four hours. If a patient requires more than thirty days, the doctor must consider 16 factors, such equally if the treatment is working and if the patient is doctor shopping. If a patient requires more than 90 days of pills, patients must undergo blood and radiology tests to determine the crusade of the pain.[44] [45]

    New Hampshire

    • Current limit: Vii-solar day limit
    • Policy: Gov. Maggie Hassan (D) signed House Pecker 1423 into police force on June 7, 2016. The law requires the land Board of Medicine, the state Lath of Dental Examiners, the state Board of Nursing, the state Board of Registration in Optometry, the state Board of Podiatry, the state Naturopathic Board of Examiners, and the state Board of Veterinarian Medicine to adopt rules for prescribing controlled drugs. The rules went into upshot on Jan 1, 2017.[46]
    • The rules prevent medical professionals from prescribing opioid prescriptions more than seven-days in an emergency room, urgent care setting, or walk-in dispensary. The rules as well require that pain patients be prescribed the lowest effective dose of pain medications.[47]

    New Bailiwick of jersey

    • Current limit: V-twenty-four hour period initial limit (acute pain)
    • Policy: Gov. Chris Christie (R) signed Senate Bill 3 into constabulary on Feb 15, 2017. The police reduced initial opioid prescriptions from 30 days to five days for astute pain. The police force also requires healthcare providers to offer 180 days of substance abuse disorder handling without preauthorization.[48] This police force does non apply to people undergoing cancer handling, receiving hospice care, in a long-term care facility, or to whatsoever medications prescribed for handling of substance abuse.
    • At the bill's signing ceremony, Gov. Christie fabricated the following argument: "I'm pleased to have signed Senate Bill 3. That's also a good indicator that I knew it was going to pass, when they give information technology a low number it'southward pretty adept. A bi-partisan measure which requires health insurance coverage for treatment of substance abuse illness besides as providing the country's strongest maximum limit of v days on initial opioid prescriptions, which often go a gateway to addiction and in fact, according to Pew, four out of five new heroin victims, new addicts to heroin start with prescription opioid drugs. Near states allow opioid prescriptions to last seven days or many states significantly longer, New Bailiwick of jersey will now lead the way in that regard. When a person who is in the throes of addiction as y'all know realizes he or she needs assist, they should not exist blocked at the treatment center doors with their life hanging in the balance, because their insurance carrier requires a pre-evaluation that could take weeks to complete. Now, with this legislation, people seeking treatment cannot be denied admission in their fourth dimension of demand."[49]

    New York

    • Current limit: Seven-mean solar day initial limit (acute pain)
    • Policy: Gov. Andrew Cuomo (D) signed Senate Bill 8139 into law on June 22, 2016. The law reduced initial opioid prescriptions from thirty days to vii days for acute hurting. This police does not apply to people suffering from chronic pain, cancer hurting, and patients in hospice and palliative care.[50] [51]
    • At the bill's signing ceremony, Gov. Cuomo fabricated the following statement: "New York is leading the mode forward in the fight against heroin and opioid addiction, and with this legislation, we are taking an affirmative represent our families and communities who have suffered from this epidemic's debilitating effects. I commend the Senate and the Assembly for their hard work and dedication to stopping this epidemic and creating a stronger and healthier New York."[52]

    North Carolina

    • Electric current limit: 5-twenty-four hour period initial limit (acute hurting) and seven-day (mail service-operative)
    • Policy: Gov. Roy Cooper (D) signed House Bill 243 into police force on June 29, 2017. The law limits initial opioid prescriptions for astute pain to five days. The law as well limits opioid prescriptions to a seven-day supply for patients after surgery.[53] The law allows for exemptions for cancer patients, chronic pain, hospice and palliative care, or medications prescribed for the handling of substance use disorders.[54]
    • At the beak's signing ceremony, Gov. Cooper fabricated the post-obit statement: "Opioid addiction and overdose have ravaged the concrete and mental health of thousands of Due north Carolinians, hurting our people and our economy, and we're taking activeness to fight it. With this legislation and the new State Opioid Activeness Plan, we're taking important first steps to stem the opioid epidemic."[55]

    Due north Dakota

    • Electric current limit: Seven-twenty-four hours limit, and ninety morphine milligram equivalents (MME) during the beginning 30-days of treatment (policy limits payment by organizations for higher dosages)
    • Policy: Gov. Doug Burgum (R) signed Firm bill No. 1139 on March 31, 2021.[ii] The bill, constructive July 1, 2022, amended the North Dakota Century Code to prohibit organizations from paying for opioid therapy exceeding 90 MME, or more than than a seven-day supply of opioid medication in the first 30 days of opioid therapy.

    Ohio

    • Current limit: Seven-twenty-four hour period limit (adults), 5-twenty-four hour period limit (minors), and thirty morphine equivalent dose (MMD) per day (astute pain)
    • Policy: Gov. John Kasich (R) announced new opiate prescribing limits in March 2017. The new rules prepare by the Ohio Medical, Dental and Nursing Boards went into effect on August 31, 2017. The rules limit opioid prescriptions to no more than a seven-twenty-four hour period prescription for adults with acute pain. Minors may exist prescribed no more than than a v-day prescription with written consent past a parent or guardian. The rules also limit patients with acute pain to an boilerplate of 30 morphine equivalent dose (MMD) per solar day. The rules do not apply for cancer patients, chronic hurting, hospice and palliative care, or medications prescribed for the treatment of substance use disorders.[56]
    • At the press briefing to denote the new opioid limits, Gov. Kasich made the following statement: "Past reducing the availability of unused prescription opiates, fewer Ohioans will be presented with opportunities to misuse these highly addictive medications."[57]

    Oklahoma

    • Electric current limit: Seven-day limit
    • Policy: Gov. Mary Fallin (R) signed Senate Bill 1446 May ii, 2018. SB 1446 established limits on prescription opioids, prohibiting practitioners from prescribing more than a seven-day supply for patients with astute hurting. The law went into effect November i, 2018.[58]

    Oregon

    • Current limit: No set pill or twenty-four hours limit. Recommends lowest constructive dose.
    • Policy: The Oregon Health Authority is responsible for setting statewide prescribing guidelines. Oregon has no fix limit on opiates merely recommends that medical professional prescribe the lowest effective dose.[59] [threescore]
    On Oct 25, 2018, the Oregon Wellness Authority released guidelines for prescribing opioids for acute hurting. The guidelines said, "Opioids should only be prescribed when necessary for acute painful conditions." The agency also said, "These statewide guidelines are intended for patients who accept had limited exposure to opioids in the by. They are not intended for those who currently receive opioids nor for those with a history of substance use (or opioid use) disorder." The guidelines continued to encourage prescribing the lowest effective dose for cases in which a medical professional person found it appropriate to prescribe opioids.[61] [62]

    Pennsylvania

    • Electric current limit: Seven-day limit (emergency rooms/urgent care centers) and seven-mean solar day limit (minors)
    • First policy: Gov. Tom Wolf (D) signed Senate Bill 1367 into law on November ii, 2016. The law limits opioid prescriptions for minors to no more than a seven-day supply.[63] Medical professionals can prescribe more than a seven-day supply if its required to stabilize the minor's astute pain. The law allows for exemptions for cancer patients, chronic hurting, and hospice and palliative care.[64]
    • 2nd policy: Gov. Tom Wolf (D) signed House Neb 1699 into police force on November two, 2016. The police force limits emergency departments and urgent care centers from prescribing more than a seven-day supply of opioids. The law also bans doctors working in emergency departments and urgent intendance centers from writing refills for opioid prescriptions. The law allows exemptions for doctors to prescribe more than a seven-24-hour interval supply if they make up one's mind its necessary. Doctors may prescribe more if its to care for a patient's astute pain or to treat pain associated with cancer or palliative care.[64]
    • At the signing ceremony for the 2 bills, Gov. Wolf fabricated the following argument: "I am proud to sign a package of bills that represents the piece of work that we accept all done together to address the heroin and opioid abuse crisis, and begins to curb the effects of this public health epidemic in Pennsylvania. Iv weeks ago, I addressed a joint session of the General Assembly to outline a ready of legislative goals that would help usa tackle this public health crisis and together, the General Assembly and my administration committed to help the victims of substance utilize disorder, and the communities that take been devastated by this terrible disease."[65]

    Rhode Island

    • Electric current limit: thirty morphine milligram equivalents (MME) per twenty-four hour period, seven-day limit (first-time prescriptions for adults), seven-24-hour interval limit (minors)
    • First policy: Gov. Gina Raimondo (D) signed Senate Bill 2823 and House Bill 8224 on June 28, 2016. The legislation limits initial opioid prescriptions for adults suffering from acute pain to 30 morphine milligram equivalents per day, for a maximum of 20 doses. Information technology does apply to patients with cancer pain, chronic hurting, and hospice and palliative intendance.[66] The legislation besides requires pharmacies to transmit prescription information to the prescription monitoring database within xx-four hours of dispensing an opioid.[67]
    • Second policy: Gov. Gina Raimondo (D) signed House Beak 5537 on July eight, 2019. The beak limited first-time opioid prescriptions for adults to a vii-day supply and put the same limit on all prescriptions for minors.[68]

    Texas

    • Current limit: X-24-hour interval limit
    • Policy: Gov. Greg Abbott (R) signed House Bill 2174 into law on June xiv, 2019. The law took upshot September 1, 2019, and required prescribers to limit opioid prescriptions for acute pain to a x-day supply, as well as prohibiting refill of opioid prescriptions. The mensurate did not utilise to opioids prescriped for chronic hurting, cancer treatment, or hospice and palliative intendance. It also excluded opioids prescribed to care for substance addiction, as long every bit the drug has been specifically approved for that use past the Food and Drug Administration.[69]

    Due south Carolina

    • Current limit: Five-day limit or 90 morphine milligram equivalents (MMEs) daily
    • Policy: Effective May i, 2018, South Carolina required prescribers to limit initial opioid prescriptions for astute pain or post-operative pain to the lowest effective dose. The state express the supply to five days or 90 morphine milligran equivalents (MMEs) per twenty-four hour period, except for cases of chronic pain, cancer pain, sickle cell disease-related pain, pallliative care, or medicatio-assisted treatment for substance abuse disorder.[70]

    Tennessee

    • Current limit: Three-twenty-four hour period initial limit for new patients
    • Policy: In May 2018, Gov. Bill Haslam (R) signed HB 1831, which established a three-24-hour interval opioid supply limit. The police allows for ten-day or xxx-day prescriptions if sure requirements are met.[71] [72]

    Utah

    • Current limit: 7-solar day initial limit (acute pain)
    • Policy: Gov. Gary R. Herbert (R) signed House Nib 50 into constabulary on March 22, 2017. The police limits the showtime fill prescription of opioids to seven days for acute pain. The police does non apply to patients suffering from circuitous or chronic conditions.[73] [74]

    Vermont

    • Current limit: Limits vary betwixt adults and minors
    • Policy: The Vermont Department of Health established new opioid rules on July ane, 2017. Doctors must assess non-opioid and not-drug treatments before prescribing opioids. Doctors must as well hash out their treatment decisions with patients.
    • The opioid limits are broken up into four categories: pocket-size, moderate, severe, and farthermost hurting. According to the rules, adults suffering from moderate pain are immune an average of 24 morphine milligram equivalents (MME) per twenty-four hour period. Patients with severe hurting are allowed an average of 32 morphine milligram equivalents (MME) per day. The table associated with the new rules too gives examples of the types of injuries and conditions that are normally associated with that pain category. Minors suffering from moderate to serve pain are allowed an average of 24 morphine milligram equivalents (MME) per solar day. Notice more on the specific pain categories here.[75] [76]

    Virginia

    • Current limit: Seven-day limit (acute pain)
    • Policy: The Virginia Board of Medicine adopted new regulations relating to opioid prescriptions on February sixteen, 2017. Gov. Terry McAuliffe (D) signed the regulations on March 13, 2017. The regulations became effective on March 15, 2017.
    • The regulations suspension down the prescribing limits for opiates between acute hurting and chronic pain. The regulations define acute pain equally pain that lasts less than three months. If a medical professional determines that opioids are required for acute pain, the regulations limit the provider from prescribing more than than a vii-day supply. Patients prescribed opioids for post-surgical pain are express to a fourteen-day supply. For acute pain and pain related to surgery, medical professional may not prescribe a longer supply unless "extenuating circumstances are clearly documented in the medical tape."[77]
    • The regulations define chronic hurting as pain that lasts more than three months. The regulations exercise non give a specific limit on opioid prescriptions. Medical professionals are required to certificate reasons for why a patient is prescribed more than 50 morphine milligram equivalents per 24-hour interval. If a provider prescribes more than 120 morphine milligram equivalents per day, the doc must document reasons for it and refer or consult with a pain direction specialist.[77] [78] Find more on information on the regulations here.

    Washington

    • Electric current limit: Medicaid plan- 20 years and younger (18 tablets) and 21 years and older (42 tablets)
    • Policy: Gov. Jay Inslee (D) signed HB1427 on May sixteen, 2017. It became effective on July 23, 2017. This legislation requires certain boards and commissions to adopt rules establishing requirements for prescribing opioid drugs. These boards and commissions were directed to prefer rules for the direction of chronic non-cancer pain through HB2876, which was signed through a partial veto on March 25, 2010. The five entities affected past the legislation are the Medical Quality Assurance Commission, Board of Osteopathic Medicine and Surgery, Nursing Care Quality Assurance Commission, Dental Quality Assurance Commission, and Podiatric Medical Board.[79]
    • The Washington Health Care Authority began to the limit opioid prescriptions for brusque-term utilize on November one, 2017, for Medicaid patients. Washington Apple Health, the state's Medicaid plan, will limit people nether the age of 20 to 18 tablets. This is about a 3-day supply. People 21 years and older will be express to 42 tablets. This is about a vii-twenty-four hours supply. Prescribers can exceed the limits if they determine its necessary. The limits practice not apply to cancer patients who are in hospice and palliative intendance and patients that have filled a long-term opioid prescription in the last 120 days.[80] [81]

    W Virginia

    • Current limit: Seven-day (curt-terrm hurting), iv-24-hour interval (emergency room prescriptions), three-24-hour interval (prescribed by dentists or optometrists)
    • Policy: Gov. Jim Justice (R) signed Senate Bill 273 on March 27, 2018. The legislation enacted procedures for opioid handling and limited prescriptions to a vii-mean solar day period for short-term pain, 4 days for emergency room prescriptions, and three days for prescriptions written by a dentist or optometrist. The pecker also required the state Chemist's Board to coordinate with the dr. licensing lath to identify suspicious prescriptions. SB 273 did non limit opioid prescriptions for cancer and hospice patients or residents of nursing homes and long-term care facilities.[82] [83]

    Background

    On November 1, 2011, the Centers for Disease Control and Prevention (CDC) issued a press release stating that overdoses from prescription painkillers had reached epidemic levels. The release specifically referenced "narcotic hurting relievers similar hydrocodone (Vicodin), methadone, oxycodone (OxyContin), and oxymorphone (Opana)." These medications are also known as opioids. Opioids are a class of drugs that are derived from the opium poppy (or, in the case of pharmaceuticals, made synthetically) and bind to nervus cells, inhibiting hurting signals. Other opioids include morphine, codeine, and heroin.[1] [84]

    According to the CDC, drug overdoses due to opioids quadrupled between 1999 and 2015, and in 2014, nearly 61 percent of drug overdoses were due to opioids. In 2015, over 31,000 people nationwide died from opioid overdoses, over half of which were from prescription opioids. Overdose deaths involving opioids in 2015 amounted to 10.4 per 100,000 population nationwide, compared to three per 100,000 population in 2000.[85] [86] [87] [88]

    In a November 2016 report, the Surgeon General of the Usa described the cause of the overdose epidemic in the post-obit way:

    " Over-prescription of powerful opioid pain relievers beginning in the 1990s led to a rapid escalation of use and misuse of these substances by a broad demographic of men and women across the country. This led to a resurgence of heroin utilize, as some users transitioned to using this cheaper street cousin of expensive prescription opioids. Every bit a result, the number of people dying from opioid overdoses soared—increasing about four-fold between 1999 and 2014.[89] "
    —Surgeon Full general of the U.s.a.[90]


    In March 2016, Massachusetts became the outset state to enact legislation to limit the supply of opioid painkillers prescribed by doctors. As of Nov 2017, 28 states had enacted similar legislation limiting the initial supply of opioid painkillers that tin be prescribed by a doctor. Opioid overdose death rates vary across united states, from 3.1 deaths per 100,000 population in Nebraska to 36 deaths per 100,000 population in Westward Virginia. Hover over the map beneath to view opioid overdose decease rates by state.[3] [91] [92]

    Nonprofit health research and consulting establish Alatrum estimated the toll of the opioid epidemic from 2001 to 2017 was $one trillion. It projected an additional price of $500 billion by 2020 from opioid misuse, substance utilize disorders, and premature mortality. These costs included lost wages, healthcare spending, lost tax acquirement, and social services.[93]

    The U.S. Department of Justice, under Attorney General Jeff Sessions, created a task strength in February 2018 to address illegal practices in the prescription drug pipeline, focusing on manufacturers, distributors, doctors, pain direction clinics, and pharmacies.[94]

    Back up and opposition

    Support

    Those who support bills limiting initial prescriptions of opioid painkillers say that the apply of the painkillers is linked to opioid abuse, heroin abuse, and overdoses. They argue that limiting the supply of opioids volition curb drug abuse and habit by preventing individuals with opioid prescriptions from developing a dependence.

    In March 2016, the Centers for Illness Control and Prevention (CDC) issued guidelines that recommended physicians limit opioid prescriptions for astute (or short-term) pain to no more than a seven-day supply. The CDC reasoned that opioid utilize for short-term hurting is associated with long-term opioid use "[b]ecause concrete dependence on opioids is an expected physiologic response in patients exposed to opioids for more than than a few days":[6]

    " Experts noted that more a few days of exposure to opioids significantly increases hazards, that each twenty-four hours of unnecessary opioid employ increases likelihood of physical dependence without adding do good, and that prescriptions with fewer days' supply will minimize the number of pills available for unintentional or intentional diversion.[89] "
    —Centers for Affliction Command and Prevention[6]


    The CDC guidelines stated that for acute pain, a three-solar day supply of opioids volition oft be sufficient, and that supplies greater than vii days are rarely needed.[6]

    Some politicians take too expressed the intent of the bills equally ending what they describe equally the overprescription of opioids and encouraging doctors to consider other forms of pain management. Sen. John McCain (R-Ariz.), who in April 2017 introduced a federal bill to limit initial supplies of opioids to seven days, stated, "1 of the main causes for the alarming increase in drug overdoses in the United States is the overprescription of highly addictive opioids. ... [T]his legislation is an important step forward in preventing people from getting hooked on these deadly drugs." Kentucky land Rep. Kimberly Moser (R-64th), who sponsored a like neb in the state legislature, said, "We felt it was important to just set up that pause button and have prescribers only finish and think about the appropriateness of what they're prescribing. Is information technology medically necessary?"[95] [96]

    Opposition

    Those who oppose bills limiting initial prescriptions of opioid painkillers say that such bills make it more difficult for patients who employ opioids correctly and as prescribed to continue to get the medication they need. They also argue that limiting the supply of prescription opioids leads users to turn to heroin instead. Writing in an op-ed for STAT, physicians Stefan G. Kertesz, MD, and Adam J. Gordon, Medico, argued the post-obit:[vii]

    " While doing and then [discontinuing opioids] could help some, it will destabilize others and likely promote the use of heroin or other drugs. ... Nosotros cannot be surprised by a flurry of reports, in the press, social media, and the medical literature describing pain patients inbound astute withdrawal, losing function, committing suicide, or dying in jail.[89] "
    —Stefan M. Kertesz, Medico, and Adam J. Gordon, MD[7]


    Kertesz and Gordon also argued that laws limiting opioid supplies are inhumane for patients with chronic pain and that there is trivial prove such laws are effective, stating "[t]here accept been no prospective clinical studies to bear witness that discontinuing opioids for currently stable hurting patients helps those patients or anyone else." Finally, the article argued that legal limits on opioids would create a blackness market for the pills.[seven]

    An article by Richard Taite for the website of Cliffside Malibu, a substance abuse treatment facility, fabricated a similar betoken about the creation of black market, stating, "[Due south]tate-based opioid prescription limits are limited to states that have them. Patients abusing opioids will exist able to drive across state borders and run across a different medico with more lenient prescribing privileges." Taite also argued that individuals subject to opioid prescription limits would exist more likely to turn to heroin.[97]

    Recent news

    The link beneath is to the well-nigh recent stories in a Google news search for the terms United States healthcare. These results are automatically generated from Google. Ballotpedia does non curate or endorse these articles.

    Encounter also

    Footnotes

    1. ↑ one.0 one.i Centers for Disease Control and Prevention, "Prescription painkiller overdoses at epidemic levels," November 1, 2011
    2. ↑ 2.0 2.one North Dakota Legislative Branch, "Bill Actions for HB 1139," accessed August sixteen, 2021
    3. ↑ 3.0 3.1 National Conference of Country Legislatures, "Summertime Progress in Opioid Misuse Prevention Legislation," August 31, 2017
    4. ↑ National Conference of State Legislatures, "Prescribing policies: States face opioid overdose epidemic," April 5, 2018
    5. ↑ National Conference of State Legislatures, "Opioid policy trends continue in 2018 legislative sessions," September 12, 2018
    6. ↑ 6.0 6.1 6.ii half dozen.3 Centers for Disease Command and Prevention, "CDC Guideline for Prescribing Opioids for Chronic Hurting — The states, 2016," March eighteen, 2016
    7. ↑ seven.0 7.1 7.2 seven.3 STAT, "Strict limits on opioid prescribing risk the 'inhumane treatment' of pain patients," February 24, 2017
    8. ↑ Function of the Inspector General of the Us Section of Health and Human Services, "FACTSHEET: Alabama'southward Oversight of Opioid Prescribing and Monitoring of Opioid Apply," accessed August 4, 2021
    9. ↑ Alaska Public Media, "Walker signs opioid addiction prevention pecker," July 25, 2017
    10. ↑ Frontiersman, "Walker signs opioid legislation in Wasilla ceremony," July 25, 2017
    11. ↑ Part of Governor Neb Walker, "Governor Walker signs legislation to increase opioid awareness, education, and monitoring," July 25, 2017
    12. ↑ 12.0 12.1 AZ Cardinal, "Ducey limits Medicaid, country insurance opioid prescriptions," October 24, 2017
    13. ↑ Function of the Governor, "Arizona Joins Together To Pass Opioid Legislation," January 26, 2018
    14. ↑ Colorado, "Colorado Medicaid to Tighten Opioid Usage Policy," July ten, 2017
    15. ↑ Colorado Springs Contained, "Colorado Medicaid changes its policy on opioid drugs in response to crisis," accessed July nineteen, 2017
    16. ↑ KUNC, "Legislature Passes Opioid Neb Parcel Supporters Say 'Will Literally Be Saving Lives'," May 11, 2018
    17. ↑ Colorado Full general Assembly, "Clinical Practise For Opioid Prescribing," accessed August 26, 2019
    18. ↑ The Office of Governor Dannel P. Malloy, "Gov. Malloy Signs Comprehensive Bill Combating Opioid Abuse and Launches Strategic Program to Tackle Addiction," May 27, 2017
    19. ↑ 19.0 19.1 The Role of Governor Dannel P. Malloy, "Gov. Malloy Signs Opioid Legislation on Overdose Awareness Mean solar day," August 31, 2017
    20. ↑ 20.0 twenty.i Delaware.gov, "New Protections for Safe Prescribing of Opiates," Feb 1, 2017
    21. ↑ Rick Scott, 45th Governor of Florida, "Gov. Scott Signs Legislation and Highlights $65 Million in Funding to Fight National Opioid Epidemic in Florida," March xix, 2018
    22. ↑ 22.0 22.one NCSL, "Prescribing Policies: States Face Opioid Overdose Epidemic," accessed October 27, 2017
    23. ↑ Press Reader, "Lawmakers tussle with nib to fight painkiller addiction," April 23, 2017
    24. ↑ Hall Render, "New Indiana Law Imposes a Seven-Day Limit on Opioid Prescriptions," June 21, 2017
    25. ↑ IN.gov, "GOV Holcomb signs bills to attack the drug epidemic, provide pre-1000 for more depression-income students," April 26, 2017
    26. ↑ Office of the Governor of Iowa Kim Reynolds, "Gov. Reynolds signs bipartisan opioid beak into constabulary," accessed Baronial 6, 2018
    27. ↑ Courier-Journal, "3-twenty-four hour period pain pill limit heads to Gov. Bevin," March 31, 2017
    28. ↑ Lexington Herald Leader, "3-mean solar day limit on painkiller prescriptions amid new laws taking effect Thursday," June 28, 2017
    29. ↑ The Advocate, "Beak to combat opioid abuse signed into law, limits prescriptions, aims to terminate 'doctor shopping'," June 12, 2017
    30. ↑ Office of the Louisiana Governor, "Gov. Edwards Praises Passage of Legislation to Fight Growing Opioid Epidemic," June i, 2017
    31. ↑ Healthe Systems, "Maine Passes Opioid Laws: 7 Day Prescription Limit, Mandatory E-Prescribing, MME Limits," April 22, 2016
    32. ↑ wcsh6.com, "Chronic hurting sufferers applaud changes to opioid limits police," June 20, 2017
    33. ↑ Maryland.gov, "Governor Larry Hogan Signs Legislation to Combat Heroin and Opioid Crisis," May 25, 2017
    34. ↑ Boston Globe, "Governor Bakery signs opioid neb," March fourteen, 2016
    35. ↑ Mass.gov, "Governor Baker Signs Landmark Opioid Legislation into Law," March 14, 2016
    36. ↑ Michigan.gov, "Michigan opioid laws," accessed Baronial 6, 2018
    37. ↑ Minnesota.gov, "2017 Legislation Affecting the Practice of Pharmacy," accessed October xxx, 2017
    38. ↑ Minnesota.gov, "Letter on Signing the Wellness and Human being Services Neb into Police force," accessed Oct thirty, 2017
    39. ↑ Missouri Dental Hygienists' Clan, "Missouri Opioid Response Efforts," accessed October 30, 2017
    40. ↑ Missouri Section of Social Services, "Opioid Crisis Response," accessed October 30, 2017
    41. ↑ Missouri Senate, "SB 514," accessed August 29, 2019
    42. ↑ 42.0 42.1 Nebraska Section of Wellness & Human Services, "DHHS Working to Combat Opioid Abuse," June 21, 2016
    43. ↑ Office of the Governor Pete Ricketts, "Gov. Ricketts Approves Major Opioid Abuse Prevention Measure out," Apr four, 2018
    44. ↑ Nevada Governor, "Governor Sandoval Completes Land'south Work from the 79th Legislative Session by Signing More than 600 Bills," accessed October 30, 2017
    45. ↑ Las Vegas Review-Periodical, "Nevada patients with chronic hurting afflict over new opioid rules," October 8, 2017
    46. ↑ Foley & Lardner LLP, "New Hampshire Finalizes Opioid Prescribing Rules," February one, 2017
    47. ↑ New Hampshire Medical Gild, "Overview of Final NH Board of Medicine Opioid Prescribing Rules," accessed October xxx, 2017
    48. ↑ Vocalisation, "New Jersey just passed 1 of the most ambitious laws to gainsay the opioid epidemic," February 17, 2017
    49. ↑ Office of New Bailiwick of jersey Governor, "Governor Christie: NJ At present Leads The Way With The Country's Strongest Reform On Opioid Prescriptions," February fifteen, 2017
    50. ↑ New York Department of Health, "Frequently Asked Questions Express Initial Opioid Prescribing," accessed Oct 31, 2017
    51. ↑ Fox News, "New York sets 7-twenty-four hour period limit on initial opioid prescriptions," June 23, 2016
    52. ↑ Governor Andrew Yard. Cuomo, "Governor Cuomo Signs Legislation to Combat the Heroin and Opioid Crunch," June 22, 2016
    53. ↑ N Carolina Medical Board, "New! Summary of NC's new opioids police, the STOP Act," June 29, 2017
    54. ↑ The News&Observer, "NC bill limiting availability of prescription hurting killers signed into law," June 29, 2017
    55. ↑ NC Governor Roy Cooper, "Governor Cooper Continues Fight Confronting Opioid Crunch, Signs STOP Act into Law," June 29, 2017
    56. ↑ Cleveland.com, "New rules limit opioid prescriptions in Ohio," August 30, 2017
    57. ↑ NBC News, "Ohio Gov. John Kasich Limits Opioid Prescriptions to Just Seven Days," March 30, 2017
    58. ↑ The Oklahoman, "Opioid prescribing laws to change Nov. i," Oct xix, 2018
    59. ↑ Oregon.gov, "Oregon Opioid Prescribing Guidelines: Recommendations for the Safe Use of Opioid Medications," accessed October 31, 2017
    60. ↑ Register Guard, "Fighting the opioid epidemic," August xx, 2017
    61. ↑ Oregon.gov, "Oregon Astute Opioid Prescribing Guidelines," accessed October 25, 2018
    62. ↑ The Lund Study, "Oregon Discourages Excessive Opioid Prescribing In Guidelines For Acute Pain," October 25, 2018
    63. ↑ The Mercury News, "Opioid crunch: It's killing immature people at an alarming rate," August 28, 2017
    64. ↑ 64.0 64.1 Allegheny County Medical Society, "Pennsylvania'due south New Opioid Laws and How They Touch Physicians," Nov 16, 2016
    65. ↑ Pennsylvania Governor, "Governor Wolf Signs Bills to Battle Heroin and Opioid Crisis," November 2, 2016
    66. ↑ Providence Journal, "Rhode Isle among v states to limit opioids in 2016," September 18, 2016
    67. ↑ Country of Rhode Island General Assembly, "Assembly OKs bills aimed at curbing opioid abuse," June xviii, 2016
    68. ↑ Insurance Journal, "Rhode Island Governor Signs Three Bills to Combat Opioid Overdoses, Deaths," July 11, 2019
    69. ↑ Texas Land Legislature, "H.B. No. 2174," accessed September 3, 2019
    70. ↑ South Carolina Healthy Connections, "Public Notice: Opioid Prescribing Limits," March i, 2018
    71. ↑ Nashville Public Radio, "Tennessee Doctors In Training Fashion As Nation's Tightest Opioid Restrictions Take Effect," June 8, 2018
    72. ↑ The Tennessean, "More than xxx new laws go into consequence Jan. i in Tennessee. Here are vii y'all should know about." Jan 2, 2019
    73. ↑ BYU, "New laws gainsay Utah opioid epidemic," July 31, 2017
    74. ↑ University of Integrative Pain Management, "Utah Makes Extensive Opioid-Related Policy Changes," March 30, 2017
    75. ↑ Vermont Public Radio, "Iv Things To Know Virtually Vermont's New Opioid Prescription Rules," April 20, 2017
    76. ↑ Vermont Department of Wellness, "Rule Governing the Prescribing of Opioids for Pain," accessed October 31, 2017
    77. ↑ 77.0 77.one Medical Society of Virginia, "New hurting regulations," accessed Nov one, 2017
    78. ↑ Hancock, Daniel, Johnson & Nagle, P.C., "New Laws and Regulations on the Prescribing of Opioid and Buprenorphine," accessed November one, 2017
    79. ↑ Washington Department of Wellness, "Opioid Prescribing," accessed November 1, 2017
    80. ↑ Union-Bulletin, "Washington land health dominance limits quantities of prescribed opioids," October 27, 2017
    81. ↑ Washington Wellness Intendance Say-so, "HCA to implement opioid clinical policy for Apple tree Health (Medicaid) on Nov. 1," October 26, 2017
    82. ↑ Charleston Gazette-Mail, "Justice OKs legislation to reduce opioid prescribing in WV," March 27, 2018
    83. ↑ Insurance Journal, "Westward Virginia Gov Signs Bill Limiting Opioid Prescriptions," Apr 2, 2018
    84. ↑ Overdose Prevention and Teaching Network, "What is an Opioid?" accessed July xi, 2017
    85. ↑ Centers for Illness Control and Prevention, "Increases in Drug and Opioid-Involved Overdose Deaths — Us, 2010–2015," December 30, 2016
    86. ↑ Centers for Illness Command and Prevention, "Drug overdose deaths in the U.s.a. go along to increase in 2015," accessed July xi, 2017
    87. ↑ Centers for Disease Control and Prevention, "Overview of an epidemic," accessed July eleven, 2017
    88. ↑ Centers for Disease Control and Prevention, "Drug Overdose Decease Information," accessed July 11, 2017
    89. ↑ 89.0 89.1 89.2 Note: This text is quoted verbatim from the original source. Whatever inconsistencies are owing to the original source.
    90. ↑ Surgeon General of the United States, "Facing Addiction in the U.s.a.," accessed July 12, 2017
    91. ↑ Governor Charlie Bakery, "Governor Baker Signs Landmark Opioid Legislation into Constabulary," March fourteen, 2016
    92. ↑ The Henry J. Kaiser Family Foundation, "Opioid Overdose Death Rates and All Drug Overdose Death Rates per 100,000 Population (Age-Adjusted)," accessed July 17, 2017
    93. ↑ Alatrum, "Economic Toll Of Opioid Crisis In U.S. Exceeded $one Trillion Since 2001," February thirteen, 2018
    94. ↑ Governing, "Trump Administration Adds Fuel to States and Cities' Opioid Lawsuits," Feb 28, 2018
    95. ↑ Medscape, "New Neb to Put 7-Day Limit on Hurting Med Prescriptions," April 19, 2017
    96. ↑ The Washington Mail service, "With drug overdoses soaring, states limit the length of painkiller prescriptions," August 9, 2017
    97. ↑ Cliffside Malibu, "Cutting Off the Supply: The Good and Bad of Opioid Prescription Limits," November vii, 2016

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