Implementation of Florida’s House Bill 21 (HB21) in July 2018 has led to reductions in opioid use and changes in opioid prescribing practices across the state, according to a research letter published in JAMA Network Open.

Florida’s HB21 was designed to limit the supply of Schedule II opioids per patient to 3 days for acute pain prescriptions, with appropriate exceptions. Researchers in Florida analyzed de-identified pharmacy prescription claims for opioids dispensed from January 2015 to March 2019 to see if the implementation of HB21 resulted in changes in opioid use and prescribing. During the study period, there were 54,409 individual opioid prescriptions dispensed. The main outcomes were new opioid users per 1000 health plan enrollees per month and mean days’ supply of opioid prescriptions per month.

A total of 8375 patients with 10,583 unique opioid starts met the inclusion criteria for the study. During the study period and prior to implementation of HB21, there were 5.5 patients per 1000 enrollees per month who began opioid use. Immediately following the implementation of the law, there was a reduction in the incidence of opioid use to 4.6 new users per 1000 enrollees per month (decrease, −0.92; 95% CI, −1.53 to −0.31; P =.005). The law was also associated with significant reductions in the use of hydrocodone (decrease, −0.48; 95% CI, −0.92 to −0.03) and the use of non-Schedule II opioids (decrease, −0.24; 95% CI, −0.48-0.001).

In addition, implementation of HB21 was associated with a reduction in the mean days’ supply of opioids from 5.4 days per prescription before implementation to 4.2 days per prescription immediately after implementation (decrease, −1.13; 95% CI, −1.78 to −0.48; P =.001). The researchers noted a continuous trend in this reduction over the ensuing 8 months (decrease, −0.13; 95% CI, −0.24 to −0.02). At the end of the study period, the mean days’ supply of opioids was 3 days.

One study limitation was the inclusion of mostly younger and healthier patients in the privately insured group, which may limit the generalizability of the findings.

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The study investigators wrote that since “there is a federal initiative to implement prescription opioid restrictions for acute pain, additional studies of these state laws are needed to inform policy makers.”


Hincapie-Castillo JM, Goodin A, Possinger MC, Usmani SA, Vouri SM. Changes in opioid use after Florida’s restriction law for acute pain prescriptions. JAMA Netw Open. 2020;3(2):e200234.