As of 2023, 24 states have passed laws that require physicians to perform urine drug testing of chronic pain patients undergoing opioid therapy. Despite the potential health and financial benefits of testing for employees and employers, there is no evidence to date regarding compliance with these state policies or their second-order effects. In this Issue Brief, we use claims data to quantify the impact of the state laws on testing rates of opioid therapy patients and document selection into treatment effects. This research provides key insights for plan sponsors and employers considering cost-effective health benefits designs to support employees with chronic pain. In particular, we find:
- Pain diagnosis rates among group plan enrollees have been relatively flat over time. Eighteen percent of enrollees were diagnosed with chronic pain; this share fell to 13 percent by 2019, before rising to 16 percent in 2021.
- Prescribing opioids for three or more months to chronic pain patients has been less common over time, falling from 10–12 percent being prescribed opioids in 2013 to 1–3 percent in 2021.
- State drug testing laws have no impact on opioid prescribing rates.
- State drug testing laws increase testing rates among chronic pain patients prescribed opioids by 4.7 percentage points (11 percent).
- Effects are largest for enrollees most affected by chronic pain and in need of long-term opioid therapy, such as workers over 45 and those working in physically demanding jobs like construction and durable goods manufacturing.
- Mandatory testing makes healthier patients more likely to receive a pain diagnosis but has negligible effects on which patients ultimately undergo opioid treatment once diagnosed.
The cumulative findings indicate that the state laws have increased testing rates, which has coincided with healthier enrollees being more likely to get a pain diagnosis. This suggests providers are more confident in diagnosing healthier enrollees with pain because urine drug testing will allow for better monitoring should they initiate opioid therapy. However, the type of enrollee who receives opioid therapy once diagnosed with pain is not a function of these state laws. In addition, enrollees who have the largest increases in testing rates are those who are most likely to require opioid therapy to treat their chronic pain, showing that urine drug tests are an important diagnostic tool for doctors seeking to responsibly treat employees most in need. As such, there are benefits to incentivizing providers to perform routine testing in states where it is not mandated.
Appendix Figure 2 Geographical Distribution of State Urine Drug Testing (UDT) Laws M25.029, M25.039, M25.049, M25.059, M25.069, M25.073, M25.076, M25.08, M25.10, M25.10, op d Hia ow ioid gnosed evp er r,e sc tis he r ibing una re aff r e e ra ca tte ls es d o on b ay fe a the v we se rdaiff gp e eolic rtehnc a ie n th e s. s in t Thi ose s e he th vp a ide rtofile dnc on’ e s tsu of pa ge ss gnr e st tolle he s t se ehs d ala t ia w ur g sine nosed (5.8 dr ug p e writ tce h ch est nt ing vs ronic .p 4.7 rov p ide a pin in st es g rcernt ea ) a, tte e indi rs w ass cit au h ting rancte ha tto Va L B sh R Subst im ac e ut riat ife tta ing kgr atr nc ions ie on d enc o ow - A i und b There n e n in us s Tr e e 20 aa a nd t 18 re me Me , som ult nt nt im e aE l He a lim ftfe e it ly a c a lt tteh Se s ion nt by es rring to v Eic nro our eas A sett la le dna m e lelini m y Csi s hara es. Fir tnt ra taion. g c st rte , eeour “ ris m Op et nt ioid e ics st for im Misu asu teb s fo se miItrnc t ing 20 re20 am ses ill an ions of A d m 2021 ongd olla m Old ay r es in fa runde Adult rls rs e e,” p c r20 le asent im 17 s . for the Appendix Figure 4 Eden Volkov is a Health Research Associate at the Employee Benefit Research Institute (EBRI). Aaron Gamino is an State Drug Testing Laws for Opioid Therapy: Implications for M25.119, M25.129, M25.139, M25.149, M25.159, M25.169, M25.173, M25.176, M25.18, M25.40, 3 t m phe aain nd rep a are hy tosi r y so c ia dm rnug e s w unob te ho sting m serv ay th eha a dt v die ndic iff b ee re a enc tne s t on es in how etst he ing fec nc ont pe rov a ribut b ide out r es s gare t iv oing highe choos a pra ing d in d iag tia o nos g tr nos e isa tris ap tta eo in p s for a he a the ie alt nt a hie lt shie in s r ernr teanr olle teos t lle e h d ea ue st. p Sp ta o ss etche ifi drc u rais g lly k , of M25.429, M25.439, M25.449, M25.459, M25.469, M25.473, M25.476, M25.48, M25.50, M25.50, SA r num eim MHS b bur erA seme of . Ap ve ant op ila t b le o le d Me a ia tg d ht nosed ictap rs:/ e a /ww w nd ith ch Me w.sa dric o m a nic id hs a ( pTe .g ain ov nnC b /da ea cr a te a us ) /s .e it The e es nr /de olle cla fae im ult s s w m /file ae ys/ rha er e for vpeor fo m t_3 e rg d18 one ica6/ ll y c Sp aurot nne e light orc e wss -e 31 raer8 yuna 6.ht and/or b m lel. t o non rec-eive care Assistant Professor of Economics at Middle Tennessee State University. Paul Fronstin is Director of Health Benefits B In 2016 oling, Inter D , na .t he “C tional om CDp Cr e ishe sCla ue ns div s a e s “P g ifi a uida in Sp canc tion of ee c ia for list ps A r Dis esnd cribing e For as m e op es r ioid ( Ow ICD sne for r) s A , cCu h grronic ee rre To pnt aP in a P .y ” roc $4 As p .1 M e ardu till of ion To ra this l T g e Se uida rmi ttlen nology c Fr ea , ud theA C lle D(g C CPT a s tio tans te ),, d” , In Figure 4, we show that there is variation in the effects of state policies mandating urine drug testing for pain Employment-Based Health Plans M25.519, M25.529, M25.539, M25.541, M25.542, M25.549, M25.559, M25.569, M25.579, M25.60, t op ce hr st io oni ing id ca la p ba w us in p s ev sh s. atould ie tho ntse s in st the tha y tb a e t de g on’ s t in tha op . tioid requir tree a tur miene nt . dH rug owteevst er ing , onc are e t1he 5 pdeia rc genosi nt m s o is r em lik ad ee ly, t to heb p e re ov mide ploy r’s ed d eb cy is ion a large firm, d re ue im b to urloc sak bd leow drns ug in r test eispons ng of ep a to in p the a tC ieOVI nts. DThe -19 e pp rose idem cuic tio . E nst of impartov es ide of rc m hror onic al ha pa za in d rd ia dg oe noses s suga gnd est op tha ioid t prus oveide arres d o 2021. Re “ pw atsea he ient n p rU. c sh a rS. unde esc tA rE tibing trB or gRI oing ne . y op Thi ’ s Offic long ioids s Iss -tfor e ue e, rm Mid B c hr rop ie d oni fioid le w c D a p s w M t is he a 2 tr 5 in, c ic r .6 ra it t 0p t , of e y M lin w nic 2b Te 5a .6 ised a it 1 nne 9 ns h a , M on s s 2 ss see houl 5.is 6t2he t, 9a , d P nc M e rus 2 e e nr 5ss .6 efr olle 3 ur om Re 9, ine M ele 2tc 5 a he ha .6 se d4 r r 9 ug I .a , ns A c Mtv 2 t te it e a 5r .st il ut 6 is a 5ing te 9 b ic , ’le s r M s. T 2 b a e 5e t .6 sea for he h 69t , te ra p M c v s:/ st h a 2e 5a r .6 /ww a rnd 7tg 3 ing e , M e w e 2 dop ff .ju 5it .6 e or ioid 7 c st 6tia , i M c of l et 2 st .g he 5 ta .he 8 ov ff r 0a ,se s. A /u pys la a a nw o n y- d s is and Healthcare Common Procedure Coding System (HCPCS) Codes for Urine Drug 10 reg p ar ed rc ing ent w le ho ss sh likould ely t o unde havre g o a long prefe -tre re rm d p op rov ioid idetrhe or rg ap aniz y is una ation ( ffe PPO cted )/ p boin y m t-aof nd -serv atoriy c e u r(ine POS t) e st pla ing. n, 12 In st pe artcees nt w it mh oraend Ouimet, P., E. Simintzi, and K. Ye. “The M25 im .80 p , a Mc2t5 .8 of 19t, he M2 5 op .82ioid 9, M2c5r.8 is3is 9, on M25fi .8r 4m 9, M v2 a5lue .859 a , M nd 25.8 inv 69e , M st2m 5.8 e7nt 9,, M ” 22020. 5.9, M2 5A .9 v, a M ila 25b .9le , at By Eden Volkov, Ph.D., Employee Benefit Research Institute; Aaron M. Gamino, Ph.D., Middle fa a unde n 11 ce b r ra p ere p rr ie or cr e ts a e nt d nd in to crrte ihe sk ase s ea xt in t ss ent oe c s ita tha ing tetd e rw a nr tite olle h s,ov w ee s a hic r-trh is b e es us ting ing a, sed bout ut on - this oft-he ne is t4.7 p st wil or l a ke p c rc os re ov nt t ide ta hg are ts, w p he oint a he lth p re eff tla e he c ns t he sh sh ow aou lth c n in ld a cronsi Fi e g cur la de ie m r . 3 a is Pr nd not oviding t h be e ing views expressed in this report are those of the author and should not be ascribed to the officers, trustees, or other c m onsi dtn/ dp err/c ur oine mp rd erhe ug ns te iv st eing -pain at- spe least cia alis nnu ts-a ally nd -tfor o am sseers -s for owne p rs re -a sc gr ribe ee-d p a m y- e41 dic-a m tion illion s a -se s w ttle ell a -fra s ot ud.he r controlled prescription Testing M25 .9 (U , MDT 25.9, )M a 25nd Ch .9, M25.9, ronic M25.9, M P 25.9a , in Conditions M25.9, M33.20, M33.90, M 35.2, M35.2, M35.2, M35.2, Figure 2 lik wit ehout ly to m ha av nda e at or heya lur th sa ine vding rug s a tecst count ing la (w Hs, t SA)he -e ligib unhle ea he lthi ae ltrh ap nd lanold , ae nd r ene nra olle rlye ts a wic re e a th s l e ik m eost ly t o likha ely v et o a uhe nde altrh go long-term September 21, 2023 • No. 592 SSRN 3338083. T ennessee State University; and M35.2P , M aul Fro 35.2, M35ns .2, M tin 35., 5, Ph.D., M35.9, M3 6Em .2, Mplo 36.3,ye M36e .4 Ben , M43.4e , M fi4t3 R .5Xe 9,s M e4a 3.5 rch I X9, M7ns 0.6t 0itut , e su p crre e bd tm rible eitatte m e dv e for ide nt m nc ad e e ja udi su n o c pa f tes ptor ion. ting tin g t he be ing fina43 nc ia pe l racnd enthe . The alth ebnr en oe lle fit ess w of it dh a rug bov test e ia ng vep ra ag in p e tr ae tiaetnt ms p entr e esc ffe ribe cts a d rop e ioids older. isThe d sponsor rugs and s of illE icB itRI d, rugs Em.p ”loy Thi es g e Buida enefit nc e Re issea sim rcp h I ly ns a r te itc ut om e-E mdeuc nda ation a tion for nd p Re rosea vide rcrh Fund s and is( E not BRI b-inding ERF), . or H ow theeirv e st r,a ff as of s. 7 op reim ioid bur the seme rapnt y onc arre a nge diag m nos ente ( dH w RA ith ch ). Mr7 onic 0.70 , p Ma 7in. 5.10 T 0, he M7se 5.50 r, eM su 76 lt .1 s indic 0, M76.2 a0 te , M t7ha 9.6t0 9 p, rM e7 sc 9.r 6ibe 46, r Ms a 85.9 re , M g 8e 9.ne 9, M ra 9lly 4.9 , rR e2 lu 9.c 4t , ant to Share of Enrollees Prescribed 3 or More Months of Opioids Category Code t Crhe eartm ma ec nk t , eS. ffeT., ct for J. Roll, M those . ag Re es ill47 y, – L56 . D a isv is 19 , U. pe r Kcie lanrtu, , aand nd tJ. heG trra eb aow tme sk ni. t e “ff Com ect pfo arris ton hos of e a Pg ae tie s nt 57 – Se 64 lf -is re 24 por p ts a ercnd ent, while im portant to justify the added costs for employee health plan providers. Neither EBRI nor EBRI-ERF lobbies or R29 tak .e 89s p 8, R osit 29.8ions 98, R 2 on 9.89 spe 8, Rc 2ifi 9.8 c9 8 p, olic R29y .8 9 p8r, op R2osa 9.89ls 8, . RE 29 B .8 RI 98 , inv R29 it.e 89s c 8, R29 om.m 89e 8, nt V1 on 3.4 this 2023, 24 states do have binding legislation that requires providers that trea8t pain patients to perform at least one urine prescribe opioids to younger pain patients, given the higher rates of abuse. Powell, D., R. Liccardo, P. E. Taylor, R. L. Pacula, and E. Taylor. “How Increasing Medical Access to Opioids Contributes the treatment effect for younger enrollees ranges from 11–15 percent, with effects increasing based on age. Older 14% Presumptive UDT Codes Urinalysis Results Obtained Under Naturalistic Methadone Treatment Conditions,” 2000. Drug and Alcohol Dependence Figure 5 also shows which chronic pain enrollees ultimately receive opioid therapy and how making urine drug testing States With UDT laws (before) States With UDT laws (after) States Without UDT laws d re rsea ug tre cst h. prior to initiating long-term opioid therapy, which is generally defined as an opioid prescription of three State Drug Testing La G0477w , G0s 478 , f G0 o 47r 9 , 0Op 007U, G ioi 0430d , G T 0431h , Ge 043r 4, a H0p 003y , 8: 0 10Im 0, 801p 01li , 80c 104a , 8t 03ion 00, 803s 01, for to the Opioid 12% Epidemic: Evidence from Medicare Part D,” 2015. NBER Working Paper Series. e In a nrolle ddit eion s arteo ap ls ro ovtide he rm m os or t alik l ha ely za tr o db , e a not prehe scrr ibe cos dt op to ioids conside for rc is hr o tha nic t t phe ain, w se ca itn yi h ov ee ld r 1 fa ls in 10 e e negnr atolle ives, es ove whicr h w the ould ag eli m of it R Int es rults oduc tion 80302, 80304, 80303, 80305, 80306, 80307 59 (1), 43–49. 2 m Thae nd fin atd oings in ry impa this cts t Ihi sss se ue B le ricetfion p are rnov ocee sl in s. Ctolu hatm tns he y 2 a arnd e the 4 show first d tha ocum t, re eg na te rd dle esvs of idenc ste a tof e la stw at e st-a letv us el p , polic ain ie ps a’t ie eff nt icsa w cyho 12% 11% m onths or more. 6 Employment-Based Health Plans 45 undergoing opioid therapy for chronic pain. Treatment effects are also the largest for employees in the wholesale, their a Ner bili ve ty P a to in10% alert doctors to patients abusing opiates or other illicit substances and refer them to treatment. Because in inc are trre Def eaatinitiv si ed ng e w UD titeh o s Tt C ing p od ioids eof s ca hr re o nm icor pe a in p likea lyt ie to nths. avThi e as e com vide prnc ehe e ns of iv the e p fir last n -(or 50 d– e67 r e ff pe erccte s of nt), the less st lik ate ely -le tvo el ur havine e a n H drug SAt- esting Chronic pain affects more than 100 million people in the United States, and a common method of treatment for chronic ICD-9: 337.0, 337.1, 353.0, 353.1, 353.2, 353.3, 353.4, 353.5, 353.6, 353.8, 353.9, 354.0, 354.1, 354.2, Rosenblum, A., M. Parrino, S. H. Schnoll 839, 25 C,. 8Fong, 0364, 80 C 10 . 2M , 8a 0x 15 w 2e , 8ll, C 0154. , M. 8016 C 0le , 8la 01nd, 66, 8S. 032Ma 3, 8g 0ur 324 a, , 8a 03 nd 25, J. 803 D 2. 6, H 8a 03d 2d 9ox. , 8033 “0 P, rescription Suggested Citation: Volkov, Eden, Aaron M. Gamino, and Paul Fronstin, “State Drug Testing Laws for Opioid 10% durable goods manufacturing, construction, and oil and gas extraction industries, where the effects range from 24 C Phou, revalen R., R. ceA of . Cr C uc hr iaon ni, D ic P . A a. in Fie Am llin, on P. g Com Grou pton, p PJ. lan T. Fa Enro rrarll , e M. esC . Haigney, C. Inturrisi, J. R. Knight, S. Otis-Green, S. e c the a ligib n b op le eia us he tee asc d lt h p t ro eefur la n o nt he n th (30 r – ree 38 sea ur in pree cr h int cdernt ug o ), tte m he 3st 5 uc 4 .3 ( he h le UD , 3 a5lt T 4 sh a .4 ) s , spe lik 3nd 5e 4.c ly 5ifi e , m 3tc 5 o a 4 pll .8 b lo y ,e 3 y d m 5 unde e 4.e t 9e nt , c 3t r 5e s m 537 .ff 0, e, 3 or c 5a t5s of p nd .1 hi , 3 ne m 5ur 5or , .2ine t ,e 3 his 5lik 5d .s 3 r eug c , ly 3 re 5 t 5e to .4 e n w , st b 3e ing. 5ould 5 37 .5, 3Thi a 5 not nd 5.6 s r , 3 old d ep 5e 5.e t 7 or e r , c . 3tt 5 C a 5sy onsi .ls 71 o nt , sh he ste ow tn ict s 80331, 80332, 80333, 80334, 80335, 80336, 80364, 80102, 80152, 80154, 80160, 80166, 80323, The earliest state to adopt such a policy was Louisiana. In 2008, the Louisiana State Board of Medical Examiners By pain is Ed p ern Volkov, escribing opPh.D., ioids. The Emp Unitloye ed Ste at Ben es is e cur fit r R ente lys e in t arch I he midst nst itut of an o e; pA ioid aro en pidM. em ic G,a w mino, ith inc P rea h.D sed ., op M ioid iddle use Op Ther ioid apy A: bus Imep lic Am atong ions E for nrolle Emep s int loym o eMe nt-tB ha ased done H e Ma altin h P tena lans nc ,” e E Tr Be RI a tI m ss eue nt, ” B r20 ief07 , no. . D r59 ug 2a (nd EmA plc loy oho eel D Be ene pefit nde Re nc sea e 90 rch (1), 356.0, 356.1, 356.2, 356.3, 356.4, 356.8, 356.9, 357.0, 357.1, 357.2, 357.4, 357.5, 357.6, 357.7, 357.8, 80324, 80325, 80326, 80329, 80330, 80331, 80332, 80333, 80334, 80335, 80336, 80337, 80338, percent to 29 percent respectively. Just like older workers, employees in these industries have the highest rates of M. 8% Marcus, D. Mehta, M. C. Meyer, R. Portenoy, S. Savage, E. Strain, S. Walsh, and L. Zeltzer. “Methadone Safety: A w drit ug h b te est ing ing old doe er sn and ’t e 7% unh nc7% ou ea rlt ag hie e rov , 7% tehe rp rsh esc arre ibing of 7% p ta 7% o in p younge atient rs aw nd ith HS more A -ve 1uligib lnerle ab p le la p ns a tfa ient llss, a . The n isele mpor cttion int ant riso k op to ioid consider. opioids, such as fentanyl and methadone, or other opioids that are structurally dissimilar such as buprenorphine, T a ov de e op nn r tte he e ds lic la se s ete ns t St w ing o a drte ee c q Un a uir deesm iv de e ent rs spit s in t ity e ; no he ac nd 3s ha 5t 7a .8 nge tP 1 e, a 3 a ul Fro 7d in 7m .3r 3ini a , 3 ts e 7t 7 s of ns r .3 a4tt ,iv 3 in r7 e e 7 , p .c 4or od Ph.D., 1, t5e e 3 d 1(.3 Lp , A a 7 in 2A Em 3d . .4m , T 7plo in. C 2 he 4.3 ye , eod 7c2onomi 7e e .2 Ben . , Tit 729c l.2 e e b 48 ur fit d R petn o . eIs 78 f o ea 01 prch I ioid thra oug ns bust h 7861 e itut , e ) The total number of enrollees in the Ma 803 rk 39 e,t 8 S 0c 3a 4n 0, 8 d0a 3t 4a 1, , 8t0 h 3e 4 2t,ot 80a 3l nu 44, 8m 03b 45e , r8 0 of 346 e, nr 80olle 347, e 8s in o 0348, 8ur 03 4c 9h , r 8onic 0350, p 80 a 3i5 n sa 1, 80m 35p 2le , , and the 64–71. Institute, September 21, 20 6% 23). 6% 6% 6%6% diagnosed and prescribed opioid use. The cumulative results in Figure 4 indicate that these laws have the biggest t Ta hekre an toge py amtohe ng r, pta he in p se arte ie su ntltss a is rsi em pil rom ar8 0 a i3 si m 5ng 3ong , 80 a3nd 5st 4, aindic 8t0e 3s w 55a , 8 tite 0h ur 3 t 5ha 6, 8 ine t0 3 ur 5 d 7ine , r8 ug 0 3 d 5r t8e ug , st 80ing t 3e 59 s, tling 8 a0w 36s a c 0, a8n b nd 036e t 1hose , a 80n im 362w , p 8it 0or hout 36t3a , nt 8, 0 3 indic a 6nd 5, 80 a p 3tow 6 ing 6, e rtful ha tt ool Clinical Practice Guideline from the American Pain Society and College on Problems of Drug Dependence, in oxycodone, and hydrocodone (McNeil et al. 2023). However, prior research has established that the false negative rate that required providers to perform a urine drug test at the start of treatment. To proceed with treatment, the urine sh ov6% a er re d ose of t, he and ovd ee ra pll s ende amnc ple e is dia eg st nosed imate d w 5% a itth ch $78. ro5 b nicill pion, ain a writ eh a sh ow t 5% hin for rd of 5% e thi a5% cs, or $28 h year fr.9 b om i20 llion, 13–d 2ue 02 1 in to su Fi bg st ua re n c1. e a The buse 80367, 80368, 80369, 80370, 80371, 80372, 80373, 80374, 80375, 80376, 80377, 82101, 82520, effects on groups most in need of opioid therapy to treat their chronic pain, showing that doctors are targeting testing t for he se allow law ing s d e on’ mp t loy influe ees w nceit t h he p ad in d ecis ia ion to gnoses ICD-1unde 0: B to 02r r .2 e g 3c o , B eop iv 26e .8 ioid 4 a, p Ep 0 tr r 8op e .4a 2tr , m ia E0t e 9en .4 tc 2 a , onc E re 10 e w .4 2hil d , ia Ee 1g 1r nosed .4 e2m , Ea 1ini 3.. 4n St 2g , ill G5 sa , 4tfe .0 he , . G rN e 54 ot is .1 , only so G5m 4.2 e c , G5 ould ev 4ide .3 , tG e nc 5 s4te .in 4 t , g ha t Collaboration with the Heart Rhythm Society,” 2014. Journal of Pain 15 (4), 4% 321–337. is low at 1.9 percent, indicating that for most cases, urine drug tests can detect patients who are abusing and are 82646, 82649, 82742, 83925, 83992, G0481, G0482, G0483, G6037, 0006U, G0480, G0659, G6031, sc cost ree s a n ha nd d inc to rebaesed cle a he r a of lth ill ic ca itr e su ut bst iliza antc ion es. (For Zhou pae tie t a nt l. s 20 re16 ce)iv . ing In a cd on dittinu ion etd o tinc reartem ased ent for hea c lth hr onic care pca oin, th sts, op e b ioi oa d ra db ’s use is Tr C num o ep sc y bo r et ig r, of h A. t In e M., nrolle form M. eV. B s in t atiosw ohe n: eMa T ll, S. his rk r ee L t. S pc or Aa ttlur n d isi, a ctH op a. y h Cra . ight s fa Hae ns lle de n o b n, y v T te he . r R. tE im m Dee p e loy frro , e m S. e a B A e b high ne di,fit J. of Re F. Ja asea ppspe ro rcxim h I r, ns a V. Sing te tit lyu 24 teh, (m EA B ill . RI ion in E. ). Jor You d 20 an, m 13 t aB y. o cW op a . y, G54.5, G54.6, G54.7, G54.8, G54.9, G56.00, G56.10, G56.20, G56.30, G56.40, G56.80, G56.90, to 4% those most in need. 3%3%3% 3%3% 3% ha the vse e cla lew ar s inf bene lue fit ns t ce o the wor dk ee cr ission to , but arls eG6 o ce 0 tiv o 32e ,e G m the 6p 03lo 4 ini , yG6 e tia r0 s l p 36 th , a G rio 6 n d 0 ugh 37ia , G6 g rnosi e 0d 41 uc , G s. e6 d I 0n s 4he 2, um G a6 lt0h c m 43, aa G6 rrye, 0 4spe m 4, a Gnda nding 6045t, or G6 y a0 nd 4 te 8, sr G6 te ing d 0uc 50c , e on Gd 6 0 te r 5ibu m 3, G ptloy 6e 0s t 5e 6 e o G57.00, G57.10, G57.20, G57.30, G57.40, G57.50, G57.60, G57.70, G57.80, G57.90, G58.7, G58.9, therefore effective tools for doctors to refer paA tieT nts t o Atre atG meL nt A (Brooke N C aE nd Daly 2018). regulations require quarterly unannounced urine tests. These quarterly tests would provide continued 2% confirma2% tion that c low Johns ost lof y on, ta o pe p R. m roxim p S. loy Ca e ic tra e s b la ly , e 14 E ca . u m Ese . illD ion it unba ca in 202 n le r, S. ad 1. H t e o Alm s t highe , he K. ov r G a . eb Va rsent all nu rley e,e m P is b . m eK r . aof nd Suc e m nr hde a olle kv e, ecJ. s in g osR. tlySw rroup etic ra e in g he o ing od alt, h p m Aor . la K en . s ha lik Ca elod ly s f d ne a ue lle y , n, to B. so ha highe a. Og sr ok the e, print, or download this report solely for personal and noncommercial use, provided that all hard copies retain any and G60.0, G60.0, G60.0, G60.1, G60.3, G60.8, G60.9, G61.0, G61.81, G61.82, G61.89, G61.9, G62.0, he t ura no lthie verr. p For atie tnt hes se bering eason mor s, ea lik dde itly iona to l r ree csea eive r ca h is ne pain d eid ae gd nosi to s doc but um ha ent s lim the itse ed d eow ffec ns tst ron ea m the b etne ype fit of s. enrollee who Chou, BR., ack P G a. inJ. Fanciullo, P. G. Fine, J. A. Adler, J. C. Ballantyne, P. Davies, M. I. Donovan, D. A. Fishbain, K. M. Foley, 2% 1% ICD-9: 720.1, 720.2, 720.81, 720.89, 720.9, 721.0, 721.1, 721.2, 721.3, 721.41, 721.42, 721.5, 722.0, G62.1, G62.2, G62.81, G63., G63., G99.0, H46.2, H46.3, H47.019, M54.10, e the mp p loy atie ee nt t ur is nov note us r ring ates ill . ic Cit o ns dris ugs tenor t w cit on h th trolle ese d csu ost bs s ta an ss coc es w iate itd hout wit h o a vp aioid lid pa re bsc usre ipti , re osea n, trhe ch ind rebyic parteees fi mp rm ting s a m reis m us or ee a num W ll c . S. op be Minor y rr d ight iag e nosed , and and ot Lw he . it Ma rh ch an pcphi rlic ok nic a ab n le tp i. anot “ in. Op ic H ioid eow s ce G ont vuide era, ine tlin he d e s in t a the ger e ahe nd in, a Ma gnd ena nde y gou e r m cm om ent ay p of osit citC eion ha h or roni quot cs r Ne on e m sm -a cine a an ll p cde or rc ons P tions ain ta ,” nof t2006 ov the er . rP teia m pior n e, t As of 2023, 24 states have passed law 7s t 22.1 ha 0, t7 r 2e 2.q 11 uir , 7e 22 .2 phy , 7Figu 2si 2.c 3ia 0, 7 nre s t 22.3 o 1 4 , p7e 2r 2for .6, 7 m 22 ur .83ine , 72 3d .0r,ug 723t .1 e, st 72ing 3.2, of 723c .3hr , 7o 2nic 3.5, 7p 2a 3in p .6, 72a 4t .0 ie 0nt , s undergoes opioid treatment once diagnosed. J. Fudin, A. M. Gilson, A. Kelter, A. Mauskop, P. G. O’Connor, S. D. Passik, G. W. Pasternak, R. K. Portenoy, B. A. Rich, M54.12, M54.13, M54.30, M79.2 A final cost to consider is that the fear of drug testing could lead patients most at risk of developing opioid addiction to 0% 724.01, 724.02, 724.03, 724.09, 724.1, 724.8, 756.10, 756.11, 756.12, 756.13, 756.14, 756.15 and adverse health outcomes. p lik indic hy ely sia cttio ing an su 9 (1 tb he st it )p, ut r1 ofile e – 39. w or of ke pras in wp ita h tie te nt chno s is log noty a in a ffec rteead s m byo tst he im de pc alin cte ed in e by nr the olle op es ove ioid erp id tim em e. icFi (g Oui urem 1 show et et al. s t2h02 at0) the . share provided that you do so verbatim and with proper citation. Any use beyond the scope of the foregoing requires EBRI’s undergoing opioid therapy. Despite the potential health and financial benefits of testing for employees and employers, Percentage Effect of Urine Drug Test (UDT) Laws on R. G. Roberts, K. H. Todd, C. Miaskowski, and the American Pain Society-American Academy of Pain Medicine Opioids be less likely to go to their doctor for pain medication and potentially turn to illegal opioids. For example, individuals Muscu2 los 0ke 13 letal Pain 2014 2015 2016 2017 2018 2019 2020 2021 ICD-9: 725.x, 726.0, 727F .0i0g , u 72r8 e .1 5 1, 729.0, 781.99, 830.0, 831.00, 832.00, 833.00, 834.00, 835.00, ICD-10: M43.27, M43.28, M43.6, M43.8X9, M46.00, M46.1, M46.40, M46.45, M46.47, M46.80, M46.90, p of rior gr oup express plan e pe nr rm olle issi eon. s beFor ing p de ia rg m nosed issions, p with ch lease roni cont c paacin t ErB eRI ma a ine t p de r rm ela istsi ivons@e ely flatb fr ri.or omg 20 . 13–2021. In 2013, 18 percent Appendix there is no evidence to date regarding compliance with these state policies or their second-order effects. In this Issue Guidelines Panel. “Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain, 2009.” Journal of Testin 8g R 36.0, 8ate 63.80 s, by Enrollee Characteristics who use recreational marijuana in stat M e4s w 7.10he , Mr 4e 7 .1 it2 , h M a4sn 7.1’t 4 , b Me 4e 7n le .16, M g4a 7liz .81 e2d , M m 47 a.8 y1 b 4, e M d 47 is .8c1our 7, Ma 4g 7.8 ed 19 , fr M om 48.0 see 0, Mk 48 ing .02, out M48 .0 m 4e , dical Source: Employee Benefit Research Institute estimates based on administrative enrollment and claims data. Sinc P oliceie 20 s t08 ha, t m he alp nyb m ala or nec e s ttahe te s ha bene ve fit a sd of opa te pd p rtop herir ia ow te c n d are rug for -t e ch string onicp olic pain iep s for atie n pta sin p wita ht ie the nt s ris unde ks ar ss going ociat e op d ioid with opioid Whitehead, S. and A. Miller. “CDC's new opioid guidelines are too little, too late for chronic pain patients, experts say,” Characteristics of Chronic Pain Patients by Urine Drug Test (UDT) of enrollees were diagnosed with chronic pain, and this share fell to 13 percent by 2019 before rising to 16 percent in M48.06, M48.06, M48.08, M48.10, M48.20, M48.30, M48.9, M49.80, M50.00, M50.20, M50.30, M50.80, B rief, we use claims data to quantify the impact of the state laws on testing rates of opioid therapy patients and Pain 10, 113–130. care for their chronic pain because of the urine drug screen. This is an important cost to consider. therapy, with Texas being the most reICD cent -10 : st Ma 2t 5e .7 2 to 9, M ad 35 op .3, tM a 6 0p .1olic 0, My 6,0 .9 in 20 , M6122 .00. , M There 61.10, M is6 2 v.1 a0 ria , Mt6 ion a 2.89, c Mr6o 2ss .9, M the 65. 0s0t,a M te 65 p .3olic 0, ies t 2023. herap N y B are C N im ew ps o. rtA avnt ail fo abrle w a or t kht erts ps: w// ho M w 5w s0t.9 w rugg 0.nb , M5 le c 1ne .0 w 4w , it M h ch s.c 51o .0m 5 ro , / M nic he 51 a .0 p lt 6a , h/ in Mhe 5 a 1.2 nd a4lt , M he-5 m ne 1.p 2w loy 5,s/ Me c 5r 1 ds w .c 26 s,- M ho ne 51 w b .2-e 7op a , M r ioid 5a 1 .sh 3- 4g ,a M uid re 51 e .3 of lin 4, tM e he s 51 - lit .3 he 5t, le alt -la h ca te-re Report Availability: This report is available on the internet at www.ebri.org Law and Chronic Opioid Treatment Status Oil & Gas Extraction, Mining 29% 2021 (Figure 1). This pattern of relatively flat pain diagnosis rates among group plan enrollees is consistent with the document selection into treatment effe Mc 6t 5s. This .4, M65.8 r 0e , M se 6a 5.r 8c 4h p 9, Mr 6ov 5.8ide 79, s k M65e .9 y, M ins 66igh .10,t M s fo 66.2 r3 p 9, la Mn 66sponsor .249, M66.s 25a 9nd , M6e 6m .26p 9loy , M6e 6r .3 s 39, M51.35, M51.36, M51.36, M51.37, M51.37, M51.44, M51.45, M51.46, M51.47, M51.84, M51.85, r a U e nd rin gat re he d ing Dr ful ug w l he tu Tes rtnov hert e in trhe g cos tR eta ss a tts es sh s soc Amo ould iate b ng de w r a it Enr ndo h ool p m ioid le or e s a s b cW he usie d t. h ulOne e C dhr a su nd on cic P h p the olic ra eiq n yuir iU s c end du r te e re rg st nt ing oi ly n a fr g e Cq Op eue ntio e nc rs for iy d . Th Ano D eis tra he ea py rse d iff Ce ont ren rol ce a is nd chronic-pain-patients-rcna74248. Construction Appendix Figure 1 25% M M5 61 6.8 .36 49 , , M M 51 66 .8 .7 3, 69 M , 5 M 16 .9 6 ,.8 M 25 9 1 , .M 9, 6M 6.8 51 7 .9 9,, M M5 61 6.9 .8, 8M , M 51 6.6 9.9 , M , M 53 6.0 7., 8M 0, 5M 3.1 67 , .M 88 5, 3M .26 X 77 .9 , 0 M , 5 M 37 .2 0X .0 83 , 9 M , 5 M 37 .3 0, .10, pattern of pain diagnosis over time in the general population reported by the CDC. Compton, P.. “The Role of Urine Toxicology in Chronic Opioid Analgesic Therapy,” 2007. Pain Management Nursing 8 considering cost-effective health benefits designs to support employees with chronic pain. In particular, we find: Having documented the potential benefits and costs of requiring urine drug tests for pain patients undergoing opioid M M7 50 3.2 .3,0 M , M 53 7.03 .3 , M 0, 5M 3.8 702 .3 , M 0, 5M 3.9 70 , M .40 5 , 4M .0 7 2 0 , M .40 5 ,4 M .07 8 0 , .M 50 5 ,4 M .17 4 0, .6 M 05 , M 4.1 75 0, .7 M 05 , M 4.1 76 0, .9 M 85 , 4M .1 77 1, .0 M0 5, 4M .2 7 ,1 M .250 4, .30, the scope of these policies. Twelve state laws apply to all physicians, seven state laws apply to pain management Prevention Man ( ufact CDC urin ) gg, uid Ne on lin du er ab for le G phy oosi ds cians who prescribe No op UDioids T Law to , P chr ain onic pain patients: urine 24% drug UDT teLa sts. w,T P he ai n CD and C The results in Figure 3 indicate that, indeS ptea nde te U ntr iof nest D atre u g la w T e st sa t t(us U, Du T r) ine La d w rug s testing rates among chronic pain M M7 54 1.3 .5,0 M , M 54 7.16 .5 , M 0, 5M 4.8 719 .8 , M 0, 5M 4.9 71 , M .9, 6M 7.7 82 8.,6 M , M 96 7.1 2.9 , M , M 96 7.5 1., 0M 0, 9M 6.1 75 , .M 10 90 6, .1 M , 7 Q7 5.1 62 .0 0, , Q7 M76 5..2 1, 0Q7 , M6 7.2 5.3 , Q 0, 7M 6.7 25 , .30, (4), 166–172. therapy, we now turn to describing the data and methods we used to evaluate the impacts of state testing laws on Enrollee Characteristics No UDT Law, Pain (1) and 90+-Day UDT Law, Pain (3) 90+-Day Prescription Wholesale 24% c Tabl re lin com ics, a e m e nd o nds f fiv C ur e o ine s nt ta te d ernt ug law s ts r e se tiq ng uir te o ur ide ine nt Q7 M7 ify 6 5 d ..4 4 r ug 1 0r9 , is , Mk Q7 t 7y e 56 st .5 b .4 0s e 9 , ha , M for Q 77 v 5 6 .8 ior c .4 0 h 9 , s r , M onic , Q 7m 7 56 .8 onit .4 0p 9 , ,a M Q or in p 7 7 66 .1 .4 d0 a r 9 ,ugs t , M ie Q7 7 nt 6 6.p .2 s se 40 r 9,e M sent e 76k.ing 4 0in t , Mw 7h 6or .e 5 0 kp ,e M arts 7ie ’ 6 .c nt 6o 0,’m s sy Mp 76 e.8 s ns t 2e 9a m , tM ion. ,7 a 6.nd, 8 9 A 9 , ne if arly patients undergoing opioid therapy rose from 2013–2021. However, when comparing testing rates before and after a • Pain diagnosis rates among group plan enrollees have been relatively flat over time. Eighteen percent of Figure 1 testing rates. M76.899, M76.899, M77.00, M77.10, M77.20, M77.9, M79.0, M79.1, M79.609, M79.7, M79.81, Prescription for for Opioids (4) Endnotes Ages 57–64 19% uniforJo mint r e Pq ain uir ement of all these stateICD polic -9: 7 ie 1s is 0.0, 7t 1ha 0.1t, 7ur 10in .2e , 7 d 10r.3 ug , 71 te 0.st 4, ing 710.8 m , 7 us 10t .9 b , 7 e1 1ini .00t, ia 7t 1e 1.d 01 for , 71 1p .0 W a 2in p , ork 711e a .0rt 3 s ie , ' 7nt 11s .0 4 w , ho 711.0 a5 r, e W orkers' st I ne nt acr te od ess auc a drop tyion , tr ee d ................................ fe ar ur the ine m d fo rug r su te bst sting anc................................ e la w us, et he dis a or vd ee ra r gte re y ae tm are ................................ ly nt inc (D re ow ase ell e in t t e al. sting 2016 r................................ a)t. eP s rio wa r s to 8 tp he er c Ce Dnt Ca g guide e........................ point liness, , which is 3 Dowell, D So., u rc Ke. : Zh Info arng, mat ion R. c Ko. mpiled Noona un, sing a nd M W 7e 9s J. .A tL 1M. a 9w , M a H 7n 9oc d .A s 2 kt9e a , tnbe M e 7 r9 e.A r gri3 s y, t. e M r“7 sMa 9 . .A Dnda a 9, ta R29 ind to .8 r ic 1 ya 8 t , P e R r o p 29 rv e .ide 8 s9e 8n , rc R e Re 2 9 o.rv 8 9 ie la 8cw , k R o 2 a9 fnd .p 9o 0, liP c Ra y 2 in C 9 b.y 9 12 , lin 0 R68 2ic 3..8 L 9a , ws Reduce enrollees were diagnosed with chronic pain; this share fell to 13 percent by 2019, before rising to 16 percent in Clinic UDT Clinic UDT Provider UDT Provider UDT Female 711.06, 711.259% 4, 711.25, 711.26, 711.27, 711 57% .28, 711.29, 711.30, 711.49, 760% 11.50, 711.51, 711.52, 711.53, 58% Pain Diagnoses Among Group Plan Enrollees, 2013–2021 Ages 47–56 19% State S01.409A, S03.00XA, S03.00XA, S03.00XS, S03.01XA, S03.01XS, S03C .0om 2XApe , S0 ns 3.a 02 ti X on S, S03.03XC Aom , pensation higher than the upward secular trend in testing rates among enrollees in states that have not adopted these policies. r pe rsea escr ribe chedr s at ha leda st ide ant tifi hre ed e -tm he ont im hp su or tp ap nly ce of of op urioids. ine te sting in addressing the potential problems of opioid misuse Law Start Law7 1 E 1nd .54, 711.55, 711.7La 4, 7w 11 .7 S5 ta , 7 rt 11.76, 711.77, 7La 11.7 w 8 , E 7nd 11.79, 711.80, 711.99, 713.0, 713.1, 713.2, the Amoun 2021. ts of Opioids Prescribed and Overdose Death Rates,” 2016. Health Affairs 35 (10), 1876–1883. B ackground ................................................................ S03.1XXA, S03.40XA, S................................ 03.41XA, S03.42XA, S03.43X................................ A, S03.8XXA, S03.9XXA, S03......................... .9XXS, S11.90XA, 4 Employed at a Large Firm 75% 76% 86% 88% PPO/POS Plan 19% UDT Start UDT End 1 713.3, 713.4, 713.5, 713.6, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 715.00, 715.04, From 2013–2021, testing rates increased an average of 3.3 percentage points per year in states that did not pass these Centers for Disease Control and Prevention S11.90 . X"Gui A, S1d 1A e .9line 0 p Xp A ,e fo Sn 1 r 1d p .9re ix Fi 0XsAc, rib Sg 1in 1u .9 gre 0 X oA p, 3 ioi S 1d 1s .9 0 fo Xr A, cS hro 11.9 nic 0X Ap , a Sin. 11.9 " 0JX o Aurn , S1a 1l .9o 0f XA p, aS in 13& .1 0p 1a Al, liative (Compton 2007; Trescot et al. 2006). However, mandatory urine testing has not been widely implemented, with Number of Enrollees With Pain Diagnoses Number of Enrollees Share With Chronic Pain Data, Study Sample, and M 7e 15t .0ho 9, 71ds 5.10 , 715.11, 715.12, 715.13, 715.33, 715.34, 715.35, 715.36, 715.37, 715.38, 715.80, Alabama Comprehens1 iv2 e/ 2 P9la /2 n013 Retail Trade 3% 6% 19% 3% 5% S13.101A, S13.101A, S13.101A, S13.111A, S13.111A, S13.121A, S13.121A, S13.131A, S13.131A, D Ur aine ta, tSt est udy Sa ing ha m sp d le is, tianc nd t a Me dvta hod ntasg ................................ es in reducing prescript ................................ ions to abusers, reduc ................................ ing diversion, and inc ........................ reasing 5 policies, suggesting that mandatory urine drug testing laws increase testing rates by 4.7 percentage points. c Fl aor ree p nc ha erma C. c So ., the C. ra Zh py o u, 30.F. 2 (L2uo, 016) a:nd 138 L. 7– 1Xu 140. 6.0. 0, The 716.0E 1c , 7 onomi 16.02, 7 c1 B 6.ur 03, d7e 1n o 6.04f P , 71r6e .0 sc 5, r7ipti 16.2 on 4, 7Op 16.2 ioi 5, d 7 1Ov 6.26 e, r7d 1ose 6.27, , 7A 1b 6.us 28, e7, 1a 6.nd 29, p hysi •c ians Pr e in sc stre ib aing d Drug r eop lying ioids O prfor iv me a trdos rhr ilye e on or ep De a m tie ornt a e t m hs self on pe -trhs ep r 1 or to ts c0 hr of 0o,d nic 0r0 ug 0 pa us P in p e opul d ae tie spit n attion by s e h waes b ll-d eoc en S um le tate, ss ent ce om d 2 e m 0 v2 on ide 0 nc ove e rof time, falling S13.141A, S13.141A, S13.151A, S13.151A, S13.161A, S13.161A, S13.171A, S13.171A, S13.181A, 19% ® Women 17% Arizona 25H ,00 MO 0,0 /E 0P 0O Pla 1n /1/2019 13% 13% 10% 10% 20% Our main data source for the study is t 71 he 6.4 Ma 9, 71 r6 k.e 50 tSc , 71a 6n .51 , 7 C1 o 6m .52 m , 7 e1r6c.5 ia 3l , 7 C 1la 6.5 im 4, s 71a 6nd .85, E 7nc 16.8 o6un , 71 te 6.8 rs D 7, 7a 16t.a 8b 8, a7se 16.8 (9 C , C 7A 16E .9)0. , Enrollee 18% adherence. First, the presence of illicitS d 13r.1 ugs, 81A, S unpr 13.2e 0X sS c, ribe S13d .4 Xd XrA ugs, , S13.or 5X Xhighe A, S13r .8-X tha XA, nS-1 e3xpe .9XXc St, eS d 2 1le .1v 0e 9A ls , S of 21.p 2r 0e 9A sc , S ribe 23.1d 0 1d Ar , ugs Dependence in the United States, 2013. Med Care. 2016;54:901–906 unde Result rrse ................................ pfr or om ting 10 (– C12 he rp m ea rc ce kn ett b................................ ael. ing 2000 pre )sc . C ribe omd p aop reioids d w ................................ ith in 201 othe3 t r m o e1 thod –3 p s of erce ................................ snt cre in 202 ening, 1. ur ine scree............................... ning is noninvasive, 6 2 716% 17.0, 717.1, 717.2, 717.3, 717.40, 717.41, 718.00, 718.01, 718.02, 718.03, 718.04, 718.05, 718.26, A limitation of this study is that, bM y en restricting the sample to chronic patients 16% who undergo long-term opioid therapy 1, 8w %e Arkansas Inf PP oO rma /PO tion S Po la n nstate laws comes from S W 23e .1 s0 t 1L Aa , S w2 68% 3 a.2 nd 0X is A, 7c S /ro 2 23 2s .2 /s 2 0- 0 X r1 e A5 fe , Sr 2e 3nc .20e Xd S 68% , u Ss 2ing 3.3X s Xta A, te S2 re 3.4g 1is XA te , rs S2.3 .4 61% 20A, S23.421A, S23.428A, 63% health insurance eligibility information, as well as medical (inpatient and outpatient) and pharmacy claims, 16% comprise the are potential indicators of drug abuse 7t1 ha 8.2t7 c , 7 a1n b 8.28e , 7 d 1e 8t .2e 9c , 7 te 1d 8. 3w 0, it 7h sc 18.31r, e 7e 1nin 8.65g , . 71E 8ns .70u , 7 r1 ing 8.71t, h 7e 18 p .7a 2t , ie 71nt 8.7 d 3, oe 71s not 8.74, 7 1t8a .9 k4e , other S23.429A, S23.8XXA, S23.9XXA, S23.9XXS, S29.019A, S31.000A, S31.000A 14% , S31.000A, S31.000A, samples are easy to store, and the test is relativel14% y low cost at $30 to $60 per test (Heit and Gourlay 2004). 20,000,000 16% HRA Plan 15% are not capturing those with chronic pain who are screened a14% way from opioids with urine testing. Given that most laws Colorado HRA Plan 718.95, 718.97 9% , 718.98, 718.99, 719.00, 7198% .01, 719.02, 719.03, 719.04, 17% 712 9./0 15 4 , /7 21 092 .2 24, 719.25, 15% Conclusion .......................................................................................................................................................... 9 C 3 CAE. The CCAE contains more than 20 S31m .00 ill 0ion co A, S31.0v 0e 0r Ae , d S3 liv 3.1e 0s w 1A, S it 3h p 3.10r1iv A, aS te 3 13% 3 he .2Xa XA lt, h insu S33.2Xr Xa Anc , Se 33 . .2 XXA, S33.2XXA, S33.30XS, Fountain, J., J. Strang, M. Gossop, M. Farrell, and P. Griffiths. “Diversion of Prescribe 13% d Drugs by Drug Users in su Sb est e • a Boli ncSt e ng s a d t(e 2021) ur ding rug .t he test ir ing trea la tm ws ent ha for ve no chrim oni pca c pta in on cop an ioid redp uc re esc m ribi ortng alitrya tre isk s.; Hall et al. (2008) find that nearly 80 719.26, 719.27, 719.28, 719.29, 719.40, 719.41, 719.45, 719.46, 719.47, 719.49, 719.50, 719.51, 14% Ages 37–46 15% require testing of chronic pain patients S3w 3.3 ho 9XA a, rS e3 unde 3.39XAr, g Soing 33.39 X long A, S3 -3 te .3r 9m XA op , S3ioid 3.5XX the A, S r3 a3p .6 yX , Xw A, it Sh o 33.8nly XX Aa , Sfe 33w .8 XrX eA q, uir S3ing 3.8XX te A,s ting ConnecticutHSA-Eligible Health Plan 8% 10/1/2019 5% 10% 7% 719.52, 719.53, 719.54, 719.78, 719.79, 719.80, 719.81, 719.82, 719.83, 720.0, 726.10, 726.5, 729.5, A Tr p 15 e pe rp ,00 c ae e tndix m 0,0 nte of 0 nt 0 ................................ : op Ana ioid lysi ov s of erdose the s inv UK Ma olv ................................ re k e ot t S he a 3nd 3r .8 c XN ont Xe Aw , S r ibut 3 D 3a .8tX ing a X A f................................ r , su om S3b 3 .st L 8X ond a Xn Ac , on e Ss. Re 33 ,” .8 X 2000 Xq Auir , S. 3 ing 3 A .9 ................................ d Xd p Xic a Ain c t , io S3n 3 lin .9 95 X ic X S ( p3) , hy S, 3si 939 .0 cia 13 1n – A, s t 4............................ S06 4o 1. .0 s 0c9rA e, e Sn p 41.0a 0t 9ie A,n t1 s 2 10 % While urine drug testing for chronic pain patients is not standard practice, as of 2023, 24 states have policies that 4 Transportation, Communications, Utilities 14% prior to initiating therapy, we believe this is the best sample to use, despite this limitation. Furthermore, Figure 2 This is done to exclude enrollees who c 7a 33 nn .90 o t be prescribed 90 or more days of pain medication because they are not on the Delaware For A g ee asc h o 14–f 26 the years spanning 2013 through 20 15% 21, we 4 /inc 1/2lude 017 d all act2% ive employees, their spouse 14% s, and their 2% S41.009A, S41.109A, S41.109A, S41.109A, S43.006A, S43.006A, S43.016A, S43.016A, S43.026A, • State drug testing laws increase testing rates among chronic pain patients prescribed opioids by 4.7 10% m rea dnd uce as t te he tha lik t p ehy lihsi ood cia ns th aptr e osc pioid ribing ab us op ICD eioids rs -1 0 c: a M p n g 0e 0r.0 for e3t9 p m , M hy 0 ur 0si .i 0c n 4ie 9 a, n p d Mr 0ug 0r.0 e5 sc t 9e ,r st M ipti 0 s0 on .0 be 69 s for , , Mone e 0 0ini .0 7of t9ia , M tting he 00.0 m 8 op , ost Mioid 00 .0 c om 9t, he Mm 0r0a on .1 p3y 9 w , a M a nd 0 y0s of , .1 in so 49, obm tae inin g Manufacturing, Durable Goods 14% S43.026A, S43.036A, S43.036A, S43.086A, S43.086A, S43.109A, S43.109A, S43.206A, S43.206A, provides strong evidence that screening chronic pain patients has no impact on opioid 4 prescribing, so there is less of a References .......................................................................................................................................................... 14 plan long enough. Florida Ages 27–36 3/16/2011 3/26/2012 15% 9% 14% 8% dependents, ages 14–64, who were enrolled in their health plan for at least 90 days. We excluded enrollees whose 10,000,000 M00.159, M00.169, M00.179, M00.18, M00.19, M00.239, M00.249, M00.259, M00.269, M00.279, 8% Green, T. C., M. R. Mann, S. E. Bowman, N. Zaller, X. Soto, J. Gadea, C. Cordy, P. Kelly, and P. D. Friedmann. “How percentage points (11 percent). S43.306S, S43.409A, S43.419A, S43.429A, S43.439A, S43.499A, S43.50XA, S43.80XA, S43.80XA, Services 14% op cases ioids , dfor uring abus ong e oing (Rose the nblu ram py . et There al. 20is 07 v; aJone riation in s and the Pa ulozzi scope 20 of 14 the ). laws, with 12 state laws applying to all physicians, concern that we are missing a significant subset of pain patients. M00.28, M00.29, M00.839, M00.849, M00.859, M00.869, M00.879, M00.88, M00.89, M00.9, M01.X0, Georgia Ages 37–46 21% 7/13/2012 21% 21% 21% S43.80XA, S43.80XA, S43.90XS, S46.019A, S46.119A, S46.819A, S46.919A, S46.919S, S51.009A, 6% carve-out claims for mental health (MH) and substance abuse (SA) treatment were not included in the dataset. The 5 Does Use of a Prescription Monitoring Program Change Medical Practice?,” 2012. pp. 1314–1323. See Whitehead and Miller (2023). M01.X0, M01.X0, M01.X0, M01.X0, M01.X19, M01.X19, M01.X19, M01.X19, M01.X19, M01.X29, Ages 27–36 12% 7 state laws applying only to providers a S51t.0 p 09 aA in m , S51a .0na 09A g, e Sm 51e .0 nt 09 A c, lin S5ic 1s, a .009A nd , S55 1 .0 s0 ta 9A te , S la 53w .0s 06r Ae , S quir 53.0 ing 06A d , S rug 53.0t 1e 6A st , S s 5fo 3.0 r 1c 6h A, ronic 4% Kentucky 5, A00 ge0 s,00 470 –56 28% 3/4/2013 37% 28% 37% M01.X29, M01.X29, M01.X29, M01.X29, M01.X29, M01.X39, M01.X39, M01.X39, M01.X39, M01.X39, • Effects are largest for enrollees most affected by chronic pain and in need of long-term opioid therapy, such as sample is further limited to enrollees with pain diagnoses, as these are the enrollees impacted by the state urine testing S53.026A, S53.026A, S53.033A, S53.096A, S53.096A, S53.106A, S53.106A, S53.116A, S53.116A, Second, urine screeC nin ompr g ha ehs entsi he ve Pl pot an ential to reduce diversion. The m 12% ajority of abusers report getting their opioids from 6 M01.X39, M01.X49, M01.X49, M01.X49, M01.X49, M01.X49, M01.X59, M01.X59, M01.X59, M01.X59, pain patients seeking workers’ compensation. There are also differences in whether the state laws require random v 2% s. Figures Author’s calculation based on claims da Sta 53..1 36A, S53.136A, S53.146A, S53.146A, S53.196A, S53.196A, S53.409A, S53.419A, S53.429A, Louisiana Ages 57–65 1/1/2008 22% 31% 22% 2/20/2020 32% Hall, Brooke, and Sarah Daly. “HelpDesk: How accurate are point-of-care urine drug screens in patients taking chronic laws. Canc wor erk p ea rs ove tients a r 45 re aand lso tho exc se lude wor d kfr ing omin p thehy sa sim ca plly le, dae s t mhe anding y are jnot obs lik sub ej e cc onst t to ru th ce tion test aing nd d re ur qa uir ble em ge ood nts t s hat other M01.X59, M01.X69, M01.X69, M01.X69, M01.X69, M01.X69, M01.X69, M01.X79, M01.X79, M01.X79, Ages 14–26 11% a friend or relative (Jones and Paulozzi 2014; Rosenblum et al. 2007). Frequent testing may allow physicians to ensure S53.439A, S53.449A, S53.499A, S53.499S, S56.919A, S56.919S, S *A 61 v.0 erage 09A, S P 6ercentage 1.009A, S61 E .2f0 fect 9A, is 11% 0 0% scheduled screening and the number of screenings reqFigur uired. Ae com 3 mon feature is that urine testing is mandated once M01.X79, M01.X79, M01.X79, M01.X8, M01.X8, M01.X8, M01.X8, M01.X8, M01.X8, M01.X9, M01.X9, Maine Source: Employee Benefit Research Institute estimates based3 o /2 n4 a/d 2m 01in 8istrative enrollment and claims data. 7 S61.209A, S61.409A, S61.509A, S61.509A, S61.509A, S61.509A, S61.509A, S61.509A, S61.509A, opioid therapy?,” 2018. The Journal of Family Practice 67.3: 177-177. opioid the mra anu pyfa pH c at S tu ie A r-nt ing Els igi .a ble re. HD ea elp th P ending lan on the year, the resulting 10% analytical sample consists of 2.1 to 4.1 million Enrollees in better health sort into plans with lower deductibles and higher premiums (HRA and HSA-eligible health plans). 2013 2014 2015 2016 2017 2018 2019 2020 2021 Fi tha gur t p er e 1, scP ribe ain D d op iag ioids noses arA e m not ong a tG too roup low Pla of n Enr a leolle vel in es, 201 a pat3 ie –nt 20 ’s 21 sy ................................ stem. If found, such a ................................ discrepancy could indic ......... ate 6 M01.X9, M01.X9, M02.10, M02.119, M02.129, M02.139, M02.149, M02.159, M02.169, M02.179, S63.006A, S63.006A, S63.006S, S63.016A, S63.016A, S63.026A, S63.026A, S63.036A, S63.036A, a minimum of a three-month supply of opioids (long-term opioid therapy) is prescribed. Share of Enrollees With Chronic Pain Who Were Prescribed 3 or Minnesota 7/13/2015 Agriculture, Forestry, Fishing M02.18, M02.19, M02.20, M 8% 02.30, M02.319, M02.329, M02.339, M02.349, M02.359, M02.369, individuals. S63.046A, S63.056A, S63.056A, S63.066A, S63.066A, S63.076A, S63.076A, S63.096A, S63.096A, t he patient failing to take the prescribed dose and instead diverting or saving the drugs. This has the potential to 8 Source: Employee Benefit Research Institute estimates based on administrative enrollment and claims data. See Substance Abuse and Mental Health M02 S.3 e7 rv 9, ic Me 0s 2 .Ad 38, minis M02.3tra 9, M tion 02.9, (2017) M05.10. , M 05.30, M05.60, M06.1, M06.4, M06.4, M06.9, M08.00, Mississip Fi pg i ure 2, Share of Enrollees Prescribed 3 or More Mont 10hs /2 8of /20Op 18ioids ....................................................................... 7 H all, A. J., J. E. Logan, R. L. Toblin, J. Sa 6. 3.1 K0a 6p Ala , Sn, 63.1 J. 06C A. , S K6 r3 a.1 ne 16r A, , S and 63.11 A6. AE , S . 6C 3r .1osby. 26A, S6“3P .1ha 26r Am , Sa 6c 3e .2ut 59iAc, a Sl O 63.2 v5 e9rA d , S ose 63.2 Fa 69t Aa , lities,” • Manda More tory tMont esting m hs akeof s he O altpio hier ids patieand nts m oA rere likeG ly ett to re ing ceiv ea Urine a pain diagDrug nosis but Test has ne (UDT gligible) effects on Conclusion HMO/EPO Plan 7% M08.3, M08.40, M08.40, M12.00, M12.129, M12.139, M12.149, M12.159, M12.169, M12.179, M12.18, r Ee vd euc n th e toug he h u suprp ine ly of drug pretsc est rip ing tion mop ay ioids bS e6 3 a.2 n a a6v 9a A ff il , S o arb 6d 3 le a .2 b 7for 9 le A , a non Snd 63. 2 -e 7 m ff 9 A e e, d c St ic 6 iv 3 ae .2 l use 8m 9Ae , a Sa n 6nd 3 s .2t9o r9e A m d , uc S a6na 3 e.3 g uni 2e 9A tnt , S ree 6a 3 nt t .5 m ion 09 eA n a , tS l o of 63v .5 e c1hr r9d Ao ose , S nic 63 d .5 pe 2aa 9in A th , sa s (fH ely all , New Hampshire 5/3/2016 2008. JAM Fi Ana 30 nce 0 (2 , Ins 2) urance, , 2613 R –2620. eal Est ate M12.19, M 2% 12.20, M12.219, M12.229, M12.239, M12.269, M12.279, M12.28, M12.29, M12.30, M12.319, We constw ru hic cth p ed our atie n atn s ault lytim icaa l sa tely m un pled e bryg us o op ing ioid diatg rnos eatm is c ent od on es in t ce dhe iag nosed inpatie . nt and outpatient claims. Pain diagnoses Our findings show th Sa ta t te st sa W tei th e UD fforT l ts atws o S6 inc ( 3b .5 e r9e fo 9a A re se , S ) 6ur 3.6iS 2 ne 9 ta A te , d Sr s 6ug W 3.6 i3 th t9 e UD A st , S ing 6 T l 3.6 a of 4 ws 9A c , h (S arft 6onic 3 e.r 6)59 p A, aS S in p 6 ta 3.8 tea X st 9 W ie A, nt iS th 6 s unde o 3u .8t XUDT 9A, rS g6 loing a 3w .9s 0X A long , S63-.t 9e 0r Xm S, opioid Fi gure 3, Share of Enrollees With Chronic Pain Who Were Prescribed 3 or More Months of Opioids and Are Getting a Urine e t al. 2008; Powell et al. 2015). there is no evidence causally identifying M1 2it .3s 29 e, ff Me 1c 2t .3 s3.9 Using , M12.3 4he 9, M a1 lt2h c .359 a,r M e1 c 2la .36im 9, M s d 12a .3t7 a9 , on M12 g .3 roup 8, M1 2 p .3 la 9n e , M1nr 2.4olle 0, Me 12 s.4 w 19it , h chronic S66.919A, S66.919A, S66.919S, S71.009A, S71.009A, S71.009A, S71.009A, S73.006A, S73.006A, New Jersey 3/1/2017 80% 73% inc thelude rapy b ha acvke, jboeint en suc , nerc ve es , sf m uus l actulo inc sk re ea 0% le st ing al, taend sting ot 5% he rart e cs hr . onic Sta 10 t e % p a pin. olicUsing ies m 15% atnda he d tirng ug 20 tc el % st aiing ms a and re 25 a RE ss %D oc BiOOK ated 30 w da % itth a a 72% fil 4.7 es, w 35e % Drug Test (UDT) ................................................................................................................................... 7 M12.429, M12.439, M12.449, M12.459, M12.469, M12.479, M12.48, M12.49, M12.50, M12.519, S73.006S, S73.016A, S73.016A, S73.026A, S769% 3.026A, S73.036A, S73.036A, S73.109A, S73.109S, 68% Share of Enrollees With Chronic Pain Undergoing Opioid Therapy (Prescribed Opioids for 3+ pain and leveraging the variation in the timing of these state-level policies, this report examines whether these state Heit, H. A. and D. L. Gourlay. “Urine Drug Testing in Pain Medicine,” 2004. Journal of Pain and Symptom Management New MexThe i70 co%cumulative findings indicate that t M he 12 .5 s2 ta 9, te M 1la 2.w 53s ha 9, M 11 1 v 2/e .5 3 0 4inc / 92 , 0 M r1 e 16 2 a.5 sed 59, M te 12 st .5ing 69, M ra 12 te .5s 7, 9, w Mhic 12.5 h 8 , ha M1s 2.5 coin 9, Mc 1ide 2.80d , M w 1it 2.8 h he 0, M1 a2lt .8hie 0, r 63% 65% 64% S73.119A, S73.129A, S73.199A, S76.919A, S76.919S, S81.009A, S81.009A, S81.009A, S81.009A, percentage point increase in testing rates. Furthermore, these state d 63% rug testing laws have no impact on rates of long- determined yearly opioid prescriptions for our chronic pain sample, excluding prescriptions for buprenorphine, 60% 61% 62% 61% A third advantage of urine screening is that it effectively sets minimum requirements for physician monitoring. M12.80, M12.819, M12.819 59% , M12.829, M12.829, M12.839, M12.839, M12.849, M12.84 59% 9, M12.859, Figure 4, Percentage Effect of Urine57% Drug Test (UDT) Laws on Testing Rates, b 59% y Enrollee Characteristics .................. 8 Months) S81.009A, S81.009A, S81.009 A, S83.006A, S83.006A, S83.006S, S83.106A, S83.106A, S83.106S, mandates impact testing rates, a policy space that has not yet been studied. This research is novel because the North Carolina 5/1/2018 27 60 % ( S3) ou, rc26 e: E 0m –267 ployee Benefit Research Institute estimates based on administrativ 54% e enrollment and claims data. Treatment effects calculated as a enrollees being more lik 53% ely to get a pain diagnosis. This suggests providers are more confident in diagnosing healthier term opioid therapy among chronic pain patients. Prescription of long-term use of opioids for chronic pain has been M12.869, 54% M12.879, M12.879, M12.88, M12.88, M12.89, M12.9, M12.9, M12.9, M12.9, M12.9, M12.9, na ltrexone, and methadone, as these are opioid antagonists used to treat opioid use disorder and not opioids used to S83.116A, S83.116A, S83.126A, S83.126A, S83.136A, S83.136A, S83.146A, S83.146A, S83.196A, 49% 50% I ncreased physician monitoring is linked to a 50 percent reduction in opioid abuse and is associated with an increased difference-in-differences model, where treatment is having a UDT 49% policy. The model also controls for state and year fixed effects. availability of claims data allows us to M tr 1a 2.9 ck , M ur 12ine .9, M t1 e2s .9 ting, , M12.op 9, M ioid 13.0p , M re 1sc 3.0r , ibing M13.0, , M and 13.0p , M a1 in 3.0d , M iag 13noses .0, M13,.0 fa , M c1 to 3.r 0s t , Mh 13 a .0 t , may all Ohio 6/20/2012 Fi 5g 0ur %e 2 uses a sample of enrollees in t S8he 3.1 9fir 6As,t S y 8e 3.2 a0 r 9tAhe , Sy 8 3a .2r0e 9 S d , ia S8 g 3nosed .219A, S w 83it .2h ch 89A, r Soni 83.3c0 X pA a, in a S83.4 nd 19A sh , Sow 83.4 s 2how 9A, S 8t 3he .50 9sh A, are of e Finr gur olle e e 5s w , Cha ith p racatin er is bt eic ca s of useC ur hrine onic d rPug ain P t 43% est ating ientw s b ill y a lUr low ine for D rb ug ettTe er st m oni (UD tor T)i ng Law sh a ould nd C thr heonic y ini t Op iatioid e opTr ioid eattm he ernt ap y. falling over time, regardless of state law status, especially after CDC guidance issued in 2016 that encouraged providers treat chronic pain. Opioids used to treat chronic pain include codeine, hydrocodone, hydromorphone, morphine, M13.10, M13.10, M13.119, M13.129, M13.139, M13.149, M13.159, M13.169, M13.179, M13.80, likelihood 39% of referring 39% problematic patie S8nt 3.6 s 0t Xo A, su S8b 3.st 8Xa 9n Ac , e S 8us 3.9e 0 Xd Ais , S or 83d .9 e0rX t Sr, e Sa 8t 6m .01 e9nt A, S (G 86r.8 e1 e9n e A, St8 6 a.l. 9120 9A, 12 S9; 1.Ma 009A n, cS hi 91 k.a 10 n9tA i e , t al. Jone s, C. M. and L. J. Paulozzi. “Blood Culture Use in the Emergency Department in Patients Hospitalized for Oklahomc tahe 40 ha% se nge e nr in r olle esponse es unde tr o gtoing hese op polic ioid iets he . Th rap eyse ha fin s c dh ings a angerd 7 e / 1 ov i/m 2e 0 pr 1or 5 tim tae nt a tnd o fa bc yili w ta he tet he futrur the e rye sea are rliv ch in i9ng /12 to in a /2t 0he 1 6st second ate wit-h a ord ur er ine Status ................................................................................................................................................... 9 to be more conservative w32% hen prescribing M13.8 0 op , Mioids 13.819for , M 1p 3.a 8i1n 9. , M Und 13.8e 2r 9st , M a 1nding 3.829, Mw 13 he .83 t9 he , M r1 u 3.8 ri3 ne 9, M d1r3ug .849t,e M st 1ing 3.859h , M elps 13. 8p 69 a, in H owever, the type of enrollee who receives opioid therapy once diagnosed with pain is not a function of these state S91.109A, S91.309A, S91.309A, S91.309A, S91.309A, S91.309A, S91.309A, S93.06XA, S93.06XA, oxycodone, oxy 31% morphone, tapentadol, tramadol, and fentanyl. Information regarding the state urine drug testing laws 2006). Adherence monitoring by physicians has been documented as a deterrent for individuals seeking to obtain a M13.869, M13.879, M13.879, M13.88, M13.88, M13.89, M13.89, M14.60, M14.80, M15.0, M15.3, Community–Acquired Pneumonia,” 2014 S93. .0JA 6XM S, A S 9I3n .1t0 e6rA n, a Sl M 93.1 e 1d 9ic A, ine S93 .1 17 194 (5 A, S9)3, .180 29A 3, – S806. 93.12 9A, S93.306A, S93.306A, S93.306S, Pennsylve C d a 30 ff r n hr ug ie a % c on tts of eic P sting the ala ise n wP . pa olic The tie ien rs etsu li C kle h t sop a sh ra ioid ow cte m tris ha isus tt ics re e, g a a b r dd y S vle erss se ta of te em 1 s L 1 tp a /a loy 2 tw 7 e/ 2 m la 0 ae w 1 nd nt 9 st ou a Opi tus tco oi , m td he e s, a Tr like e nd a lih tme ot ood he n r ttha s. S tIt n a a a tcus d hr do it nic ion p to ain dep m aonst tientr a is ting physicians make better treatment decisions, discerned by examining reduced misuse and overdose mortality, is an laws. In addition, enrollees who have the largest increases in testing rates are those who are most likely to require M15.8, M15.8, M15.9, M16.10, M16.7, M16.9, M16.9, M17.10, M17.5, M17.9, M17.9, M18.9, M19.019, Appendix Figure 1, State Urine Drug Test (UDT) Laws ............................................................................................ 10 was collected from WestLaw and state registers. This information is summarized in Appendix Figure 1, and a map of S93.316A, S93.316A, S93.316A, S93.316A, S93.326A, S93.326A, S93.336A, S93.336A, S93.336A, prescription for diversion (Fountain et al. 2000). Monitoring can also lower the risks associated with opioid prescribing prescribed three or more months of opioids has fallen over time. After falling from 10–12 percent in 2013 to 6–7 Tennesse20 e % 9/30/2011 M19.029, M19.039, M19.049, M19.079, M19.219, M19.229, M19.239, M19.249, M19.279, M19.90, im the p or firtsatn -or t ne dext r e q ffue ecst ts of ion to thea sns e st we at re . Ip f inc olicie resa, sed this t e Iss sting ue B craie n r f sh edow uce s how adve rtse he he profile alth o s of utc a om ll cehs, ronic enc ou parin p aging atietn he ts se and test the s In the final component of our analysis, w S93.3 e3 e 6A v,a S lua 93.4 te 09 w A, he S9t 3he .41r 9 Ap , a Sss 93ing .429Aa , S u9r3ine .439 d Ar , ug S93.4 te 9st 9Aing , S93la .5w 19 A im , Sp 9a 3c .5t2s9 A the , S9 3 ty .6p 09 eA of , opioid therapy to treat their chronic pain, showing that urine drug tests are an important diagnostic tool for doctors the geographical distribution of state policies is shown in Appendix Figure 2. This figure shows that states that passed M19.90, M19.90, M19.90, M19.90, M19.90, M19.90, M19.90, M19.90, M19.90, M19.90, M19.91, b Ma y nc ma hi kk ing antsu i, L re ., tR. he Ma dosa nchu gek iond s right a, K . . There S. Daa m rr eon, maD ny . B prot an ed nt on, ia lly C . fa Dt. al r Mc is Ma ks a nus ss, oc and iateK d. w Ca its h th h. “eD fa oeilu s A red he to rpeenc rfor e Monit m regor ula ing r Appendix Figure 2, Geographical Distribu S93.6 tion o 09S, Sf St 93.6a 2t 9e A , Ur S9in 3.6 e9 9 D Ar , ug S96Te .919 st Aing , S96( .UD 919A T) , S L 96 a.9 w 1s 9 S ................................ , T14.90, T14.90, T14.90, Z8.............. 9.019, 11 Texas p10 er% cent in 2011 4, o 1/9/p 20 ioid 22 prescribing rates stabilized until 2016, after which they fell to 5–6 percent in 2017 and through higher reimbursement rates for providers or lower cost sharing for enrollees are cost-effective ways for group subset who undergo long-term opioid therapy have changed when urine drug testing was mandated. These descriptive enrollees who are diagnosed, the typeM of 19.9 e1nr , M olle 19.9e 3s , M w 1ho 9.93se , Me 2k 2.4 out 0, M 2 tr 3e .0a 0t 9m , Me 2n 3t .2 for 02, Mc2hr 3.2 oni 29, c M p 23 a.2 in 3, 9 , a M nd 23.2 w 4he 9, M the 23.2 r 5t9ho , se seeking to responsibly treat employees most in need. As such, there are benefits to incentivizing providers to perform Z89.029, Z89.119, Z89.129, Z89.209, Z89.219, Z89.229, Z89.239, Z89.419, Z89.429, Z89.439, urine drug testing policies are generally concentrated in the South and Northeast. The states with UDT policies also Reduce Controlled Substance Abuse in Chronic Pain Patients?,” 2006. Pain Physician 9 (1), 57–60 ult urine ima tte est lyi ng to 1 in c –3onj peun rcecn tio t in 202 n with ca 1. Thi reful s p trie trcaipit tioou n o s f me declin tha ed ione n op in t ioidhe p rp ersc oc ribing ess of aa ftd ejru 20 sting 16 a is p ca on tie sint st’e s d ntosa witg he ne (Cw ho s u et Virginia he 0% alth plan sponsors to support a heaM lth 23y .2 a 69 nd , M2 p3r.od 305uc , Mt3 2 iv 3 /1 e .3 5 2/w 9 2, 0 or M 12 k 73 .3 for 39c , M e.2 3.349, M23.359, M23.369, M23.40, M23.50, M23.50, Z89.449, Z89.519, Z89.619, Z89.629, Z89.9, Z96.60, Z96.619, Z96.629, Z96.639, Z96.649, Z96.659, fin diad gings nosed pr ov wit ide h ch ins roni ight c s in pain toa w rehe ptrhe esc r rm ibe ak di ng thrd er eug ort m est or in eg m m ont anda hs tof ory op le ioids. ads t o The sele re csu tion lts in c into olu chrm onic ns (p1) ai n d and ia( g3 nos ) in es or Appendix FigurEBRI Is e 3, Dsr uug e Bri Ov ef e is re rdose giste rD ede ia n tths he U p.e S.r P10 ate0,00 nt and0 P Traop dem ula ark tion b Officey . IS SS ta Nt:e 0, 88 20 7 –20 137 ................................ X/90 0887 –137X/90 $ .50+.5 ................... 0 11 routine testing in states where it is not mandated. M23.50, M23.50, M23.50, M23.50, M23.8X9, M23.8X9, M23.90, M24.00, M24.00, M24.019, M24.029, correspond closely to the set of states that have been hardest hit by the opioid epidemic, suggesting these laws were 2013 2014 2015 Z96.669, Z9620 .6916 8, Z97.10 2017 2018 2019 2020 2021 reports documenting that doctors were much more reluctant to prescribe opioids to their pain patients after the CDC al. 2014; Hall et al. 2008; Chou et al. 2009). West Virginia 5/1/2016 Fi gure 5 show that enrollees diagnosed with chronic pain in states that do and do not require urine drug testing are opioid therapy by providers and/or group M24.0 p 3la 9, n e M24nr .04 olle 9, Me 2s 4. .0T 59he , M 2 c4um .073 ul , M at 2i4v .0 e7 6 fin , Md 2ings 4.08, M are 24. 1i0 m , M por 24.t1a 0nt , M 2 fo 4.r 1 2set 9, M ting 24.1 3c 9os , t-effective © 2023, Employee Benefit Research Institute—Education and Research Fund. All rights reserved. 5 Our McN e re il S su. ltE s a ., lC so he indic n R. aJt.e, tahnd at C dog octbor urs h n M av . e“ D inc rug rea Te sed sting test ,”i ng 2023 rat .. es t Sta he tP e m aost rls, fo avra e ila nr bolle le aets w ith the highest rates of Appendix Figure 4, International Classification of Diseases (ICD), Current Procedural Terminology (CPT), and likely Ot pa hs esed r Chr ow nic ith th Pain e goal of limiting abuse (Figure A2). The DX9 and DX10 codes used to define pain diagnoses and issued its 2016 guidelines recommending M24.1 m 49or , M e2 4 st .1r5inge 9, M2nc 4.1y 7 3on , M2t4 he .17 6 p,a M r2 t 4of .30, pM a2 in 4.3 p 0hy , Msi 24c .3 ia 0ns , M. 24 .319, M24.329, M24.339, Source: Information compiled using WestLaw and state ICD reg -9is : 3 te 3rs 8.2 . 9, 338.4, 729.1 very simSo ilaurrc on e: Em ma plny oye d e im Bee ne ns fit iRes onse. aSixt rch In ys p titu er tec e es nt tim a ar te es fe bam sea dle on , 3 ad p me inric se tra nt tiv e ha en vro e lla m e cn om t anp dr e clhe aimns s div ae ta .health plan, 10–13 percent health benefits policies for employers. M24.349, M24.359, M24.40, M24.419, M24.429, M24.439, M24.443, M24.446, M24.459, M24.469, chronic pain and opioid therapy use, indicating that these tests are important diagnosis tools for physicians treating Healthcare Common Procedure Coding System (HCPCS) Codes for Urine Drug Testing (UDT) and Chronic https://www.ncbi.nlm.nih.gov/books/NBK459334/ D the espit CPe T 4/ all t HC he PC b Se c ne od fit es of s use te ds tting, o idetnt heify re ur arine e im dp rug ort a te nt s tc ing os tc sla to imcs on ar si ed c eont r. Fi arine st, dt he in A rep m pe andix y be Ta prov bleide A2. r m oral hazard have a health maintenance organizatio Mn 2 4( .4 H 7MO 3, M) 2/ 4e .4xc 76lu , Msi 2v 4.6 e 0p , M rov 24ide .60, r M or 24g .6a 0, nM iza 24t .6 ion ( 19, ME 24 P.6 O 2) 9 , he M2a 4lt .6h p 39, M la2n, 4.614 49, – M15 24 .6 p 5e 9r , cent are ICD-10: G89.29, G89.4, M60.9, M79.1, M79.7 Figure 2 also shows that in all years except 2013, mandating urine drug testing had no impact on opioid prescribing patients wPho ain C neond ed cit aion re s the ................................ most. Furthermore, ................................ healthier enrollees are ................................ more likely to get a p ................................ ain diagnosis once ur..... ine 12 M24.669, M24.673, M24.676, M24.80, M24.80, M24.80, M24.80, M24.80, M24.80, M24.819, M24.819, where paS in p ourc hy e:si CcD ia Cns , N h ata ion ve a l a C fin enta en r c foia r l inc Healte hn S tiv tae tis t tic o sov . Or eigin r te ast l c.h A ar tp arv om ailaine ble natt example of this is the case of a Tennessee- ages 14–26, 14–15 percent are 27–36, 21 percent are 37–46, 28 percent are 47–56, and 22 percent are 57–64. rates. Figure 2 further shows that eveM n b 24.8 efor 29, e M 2m 4.a 82 nda 9, Mt2i4 ng .839 ur , M ine 24 .8d 3r9ug , M2t4 e .8 st 4s, st 9, M2a 4.t 8e 4s t 9, M ha 24t.8 p 59 a,ss M 2t 4he .85se 9, Mla 24 w .8s ha 73, Mv 2e 4.8 highe 73, r d rug testing is mandated, but the type of patient who is ultimately treated with long-term opioid therapy once https://commons.wikimedia.org/wiki/File:US_map_of_drug_overdose_deaths_per_100,000_population_by_state.png. based medical group called Comprehensive Pain Specialists (CPS). CPS operated over 40 pain clinics in 12 states before M24.876, M24.876, M24.9, M24.9, M24.9, M24.9, M24.9, M24.9, M24.9, M25.00, M25.00, M25.019, e e e e e e e e e e e e e eb b b b b b b b b b b b b br r r r r r r r r r r r r ri. i. i. i. i. i. i. i. i. i. i. i. i. i.o o o o o o o o o o o o o or r r r r r r r r r r r r rg g g g g g g g g g g g g g IIIIIIIIIIIIIIs s s s s s s s s s s s s ss s s s s s s s s s s s s su u u u u u u u u u u u u ue e e e e e e e e e e e e e B B B B B B B B B B B B B Br r r r r r r r r r r r r rief ief ief ief ief ief ief ief ief ief ief ief ief ief A r e • • • • • • • • • • • • • •s e S S S S S S S S S S S S S Sa e e e e e e e e e e e e e erp p p p p p p p p p p p p p ctttttttttttttth e e e e e e e e e e e e e e mbe mbe mbe mbe mbe mbe mbe mbe mbe mbe mbe mbe mbe mbe repor r r r r r r r r r r r r rr t2 2 2 2 2 2 2 2 2 2 2 2 2 2 f1 1 1 1 1 1 1 1 1 1 1 1 1 1 ro ,,,,,,,,,,,,,, m 2 2 2 2 2 2 2 2 2 2 2 2 2 20 0 0 0 0 0 0 0 0 0 0 0 0 0t2 2 2 2 2 2 2 2 2 2 2 2 2 2 h3 3 3 3 3 3 3 3 3 3 3 3 3 3 e E • • • • • • • • • • • • • • B N N N N N N N N N N N N N NR o o o o o o o o o o o o o o..............I 592 592 592 592 592 592 592 592 592 592 592 592 592 592 Edu cation and R esearch Fund © 2023 Employee Benefit Research Institute 12 13 10 14 15 11 6 4 9 5 8 3 7 2