Relationship Between State Policies Targeting Unethical Treatment Practices and Opioid-Related Outcomes: An Event Study Analysis.

Objectives: To estimate the effect of the passage of state laws targeting patient brokering on opioid-related outcomes.

Background: In response to growing awareness of unethical substance use disorder (SUD) treatment practices, several states in the United States have passed laws targeting patient brokering and deceptive marketing. Patient brokering and deceptive marketing laws are intended to reduce the chances individuals with SUD interact with bad actors or suffer from adverse outcomes related to inappropriate SUD treatment, but the effectiveness of these laws is unknown.

Methods: Matched event study analysis comparing early population-level outcomes in 6 states that passed laws targeting patient brokering between 2018 and 2019 and 24 comparison states with similar census region and presence of recovery residence regulations, anti-kickback laws, state SUD task forces. Outcomes, analyzed through 2019, included monthly rates of opioid-related mortality and quarterly rates of opioid-related emergency department visits and hospitalizations per 100,000 residents, and state-year prevalence of unusual patterns of claims for SUD-related services.

Results: In 2018, there was a mean of 326.9 (SD = 72.0) opioid-related hospitalizations/100k state residents, 234.6 (SD = 37.7) opioid-related ED visits/100k state residents, and 122.9 (SD = 73.6) opioid-related deaths/100k state residents in the states in our treatment group. We did not observe evidence that passage of state laws targeting patient brokering or deceptive marketing was associated with changes in any of our outcomes.

Conclusions: The passage of state laws targeting patient brokering is not associated with significant changes in opioid-related outcomes. Additional resources may be needed to accompany implementation and enforcement efforts before desired policy effects are realized.