EBRI Issue Brief

State Drug Testing Laws for Opioid Therapy: Implications for Employment-Based Health Plans

Sep 21, 2023 15  pages


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.