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Background Physically injured patients are at high risk of exposure to and subsequent long-term pain control related opioid use. This study aims to examine hospital and emergency department (ED) discharge opioid prescription in injured patients before and after implementation of state policy restricting opioid prescription and through the COVID-19 pandemic.Methods This was a longitudinal, single-center retrospective study in Washington state (WA) from January 1, 2016 to December 31, 2019, and from March 1, 2020 to May 31, 2021. These study time periods are split into T1 (January 1, 2016 to December 31, 2018), T2 (January 1, 2019 to December 31, 2019), and T3 (March 1, 2020 to May 31, 2021), reflecting before and after the implementation of opioid restricting legislation, as well as after the start of the COVID-19 pandemic. Opioid medication is standardized as oral morphine milligram equivalent (OME). Univariate and multivariate linear regressions were used to examine total discharge OME over the three time periods and any potential contributing factors.Results The study cohort consisted of 22,130 patients, with a mean (SD) discharge OME of 570 (1,149). The OME for T1, T2 and T3 were 694, 404, and 364, respectively. Compared with T1, there was a significant decrease in the proportion of injured patients discharged with any opioid medications (72% vs. 69%, p<0.05) and the total discharge OME in T2 (−288.5: (−329.0 to −248.1); p<0.05). During T3, there were no significant changes to the total discharge OME compared with T2; the number of patients discharged with opioids also remained similar.Conclusion There was a temporal association between implementation of state policy restricting opioid prescription and hospital and ED discharge OME among injured patients. This pattern continued through the beginning of the COVID pandemic, which points to the potential enduring effect of state policy on opioid prescription.Level of evidence II-3.