NC STOP Act Evaluation


What are we studying 

In an effort to address growing concern of overprescribing of opioids, state governments in the US have passed laws limiting the amount of opioids that can be prescribed. In North Carolina, the NC STOP Act set a legal “cap” targeting the days’ supply of first opioid prescriptions for acute and post-surgical pain prescriptions to 5 and 7 days, respectively. We are evaluating if this law has changed prescribing behavior or reduced fatal and non-fatal opioid overdoses. Furthermore, we are examining the systems, strategies, partnerships, and resources at the state, hospital systems, and the prescriber level that facilitated implementation of the law in North Carolina.

Why it matters

Limiting opioid prescribing for first-time acute and post-surgical pain patients has been demonstrated as effective at reducing long-term opioid use, opioid use disorders, and opioid overdose. The identification of successful and unsuccessful strategies, including laws and policies, to limit excess opioid prescribing are critical for addressing the opioid epidemic.

How are we studying it 

We are conducting a mixed methods evaluation of opioid prescribing limits legislation in North Carolina. We have conducted a total of 67 qualitative interviews with state officials, hospital administrators, and prescribers to better understand the barriers and facilitators to implementation of state-mandated prescribing limits. We have surveyed 201 acute and/or post-surgical pain patients to better understand how patients have been impacted by the legislation. And we are using large healthcare data from three University based healthcare systems in two states linked with mortality and prescription monitoring program data to examine the impact of policy on prescribing behaviors and overdoses.

How to use the results 

In our first qualitative study with hospital administrators and prescribers we identified three key themes around implementation of the STOP Act within healthcare settings: organizational communication, prescriber education, and changes to the IT systems. Effective strategies for implementation of prescribing limits, according to hospital administrators, included dedicating resources to email and in-person communications and to changes in the electronic medical record system. Prescribers’ reactions to these implementation strategies indicated that there was no one-size-fits-all approach.

The results of our study will provide better understanding of the impact, the barriers and facilitators, and the patient satisfaction of implementation of state-mandated prescribing limits. Our recommendations inform and improve future legislative initiatives.

Who is conducting and supporting the study 

This study is led by Shabbar I. Ranapurawala, PhD, Assistant Professor of Epidemiology at the University of North Carolina at Chapel Hill. The study is funded by the National Center for Injury Prevention and Control at the United States Centers for Disease Control and Prevention (R01 CE00309; Pi: Ranapurwala). The research team consists of researchers at University of North Carolina at Chapel Hill, Duke University, and Vanderbilt University. This study has been registered with the UNC-Chapel Hill, Duke University, and Vanderbilt University Institutional Review Boards. All studies presented on the Opioid Data Lab do not represent the views of funding organizations.

Shabbar Ranapurwala
Epidemiologist, Physician

Maryalice Nocera
Project Manager, Nurse

Nabarun Dasgupta
Epidemiologist, Factotum

Samantha Dorris
Project Manager

Elizabeth Joniak-Grant