Authors: Robert Winkelman; Robert Winkelman, BS; Michael Kavanagh; Joseph Tanenbaum, PhD; Dominic Pelle, MD; Edward Benzel, MD; Thomas Mroz, MD; Michael Steinmetz, MD (Cleveland, OH)

Introduction: On August 31 st , 2017, the state of Ohio put into effect legislation limiting the dosage and duration of opioid prescriptions. Despite the widespread adoption of such restrictions across the country, little research has been done regarding their effects on prescribing. As opioids are a mainstay in the management of acute postoperative pain following spine surgery, we sought to evaluate the effect of the recent state-level reform on prescribing practices and patient-reported outcomes (PROs) at our institution following lumbar decompression. Methods: This study is a retrospective review of the postoperative opioid prescribing practices at a single healthcare system for patients undergoing a one/two-level lumbar laminectomy between 9/1/2016–8/31/2018.  Patient demographics, opioid medication orders, and PROMIS Global Health (PROMIS-GH) scores were obtained from institutional databases. Using these data, a comparison of 90-day post-discharge opioid prescriptions was performed between patients who underwent surgery in the year preceding (9/1/2016–8/31/2017) and the year following (9/1/2017-8/31/2018) the reform implementation. Results:   One thousand and ninety-eight patients underwent one/two-level lumbar laminectomy surgery during the two years evaluated. Patients undergoing surgery in the year following the reform were found to have received, on average, 174 fewer morphine equivalent doses (MEDs) (95% CI: -261 to -91) over the 90 days following discharge compared to patients who had surgery in the year prior. No difference in the overall number of opioid prescriptions written or PROMIS-GH scores was noticed between the two years. Conclusion: Our retrospective analysis found that patients undergoing one/two-level lumbar laminectomy after the implementation of an opioid prescribing reform received significantly less MEDs while reporting no change in the total number of opioid prescriptions or PROs.  These results demonstrate that state-level reforms placing reasonable limits on opioid prescriptions written for acute pain may decrease patient opioid exposure without negatively impacting PROs following surgery of the spine.