Investigating the Relationship Between Opioid Prescription Frequency and Deaths From Illicit Opioids

Investigating the Relationship Between Opioid Prescription Frequency and Deaths From Illicit Opioids Cara Wyant, OMS-II Taylor Cornwell-Hinrichs, MPH, MLIS, OMS-II Joseph P. Hardy, MD, Associate Dean of Clinical Education Weldon Havins, MD, JD, LLM, MA, Emeritus Professor Touro University Nevada College of Osteopathic Medicine In accordance with the global opioid epidemic, the CDC issued guidelines for practitioners prescribing opioids for chronic pain. In response to these guidelines and to the opioid epidemic itself, Nevada issued restrictive legislation on practitioners prescribing opioids: SB 459, AB 474, and AB 239. To investigate the relationships between opioid legislature and opioidrelated death rates, data was obtained from the Nevada Board of Pharmacy and the Clark and Washoe County medical examiner offices. The data demonstrate that there was a significant decrease in prescriptions following the legislation; however, there was no correlation between the legislation and overall rate of opioid-related deaths because there was a subsequent and dramatic rise in deaths from illicit opioids. This suggests that more patients switched to the use of heroin and/or fentanyl as a result in limiting legal opioid prescribing power. A Spearman correlation was calculated (-0.04) and a two-way analysis of variance (ANOVA) was used to compare the time periods of the legislation implementation and the county. There were no interactions between the two counties and law; so, both counties experienced the same trends following these laws. To compare opioid-related deaths to opioid prescription rate for each time period, a t-test with law as the only factor was conducted with combined data from both counties (SB 459 p1⁄4 0.744; AB 474 p1⁄4 0.640; AB 239 p1⁄4 0.704). No significance was found. The COVID-19 Stay at Home order has statistically increased opioid-related deaths (p1⁄4 0.010), albeit it is unknown if this increase is due to Nevadans selfmedicating in response to work stoppages and financial stress, inability to see a practitioner in person, or restrictions involving addiction clinics during the pandemic. The goal of Nevada’s three opioid prescription bills was to reduce the rate of Nevadans dying from opioid overdoses, yet more Nevadans are dying from opioids now than before the bills passed. We recommend three provisions that will allow providers to confidently prescribe appropriate 2021 American College of Legal Medicine JOURNAL OF LEGAL MEDICINE 2021, VOL. 41, NO. S1, 49–50 https://doi.org/10.1080/01947648.2021.1914493 pain management for their patients without fear of sanction from another licensing board’s misunderstandings, allow providers to humanely manage their patients’ legitimate pain, and limit unintended consequences where patients are forced to seek out illicit opioids to control their pain and inadvertently die in the process. These are our recommendations: (1) Base law requirements on guidelines provided by professional or governmental agencies that are medically oriented, (2) Discipline first with education, then with sanctions, and (3) Enforce requirements through an entity which is very familiar with the providers’ scope of practice, such as the Nevada State Board of Medical Examiners and the Nevada State Board of Osteopathic Medicine. References upon request. 50 ABSTRACT