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Effects of state opioid prescribing laws on rates of fatal crashes in the USA
  1. Sarah A White1,
  2. Emma E McGinty2,
  3. Alexandra N Origenes1,
  4. Jon S Vernick1
  1. 1Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
  2. 2Division of Health Policy and Economics, Weill Cornell Medical College, New York, New York, USA
  1. Correspondence to Sarah A White, Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA; swhite3948{at}


Background State opioid prescribing cap laws, mandatory prescription drug monitoring programme query or enrolment laws and pill mill laws have been implemented across US states to curb high-risk opioid prescribing. Previous studies have measured the impact of these laws on opioid use and overdose death, but no prior work has measured the impact of these laws on fatal crashes in a multistate analysis.

Methods To study the association between state opioid prescribing laws and fatal crashes, 13 treatment states that implemented a single law of interest in a 4-year period were identified, together with unique groups of control states for each treatment state. Augmented synthetic control analyses were used to estimate the association between each state law and the overall rate of fatal crashes, and the rate of opioid-involved fatal crashes, per 100 000 licensed drivers in the state. Fatal crash data came from the Fatality Analysis Reporting System.

Results Results of augmented synthetic control analyses showed small-in-magnitude, non-statistically significant changes in all fatal crash outcomes attributable to the 13 state opioid prescribing laws. While non-statistically significant, results attributable to the laws varied in either direction—from an increase of 0.14 (95% CI, −0.32 to 0.60) fatal crashes per 100 000 licensed drivers attributable to Ohio’s opioid prescribing cap law, to a decrease of 0.30 (95% CI, −1.17 to 0.57) fatal crashes/100 000 licensed drivers attributable to Mississippi’s pill mill law.

Conclusion These findings suggest that state-level opioid prescribing laws are insufficient to help address rising rates of fatally injured drivers who test positive for opioids. Other options will be needed to address this continuing injury problem.

  • policy
  • mortality
  • driver
  • drugs

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Contributors EEM and JSV conceived of the presented idea. SAW and EEM led the quantitative analysis. ANO and JSV led the legal mapping. All authors discussed results and contributed to the final manuscript. SAW acts as the guarantor.

  • Funding This work was funded by CDC grant 5R49CE003090.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.