Trends in Opioid Death Rates Following Implementation of Nevada’s Opioid Prescribing Laws

Taylor Cornwell-Hinrichs; Cara Wyant; Cheryl Vanier; Weldon Havins; Joseph Paul Hardy

doi:doi:10.11648/j.ajim.20210904.17

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Trends in Opioid Death Rates Following Implementation of Nevada’s Opioid Prescribing Laws

Taylor Cornwell-Hinrichs, Cara Wyant, Cheryl Vanier, Weldon Havins, Joseph Paul Hardy

Published in American Journal of Internal Medicine (Volume 9, Issue 4)

Received: 19 July 2021 Accepted: 29 July 2021 Published: 4 August 2021

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Abstract

In response to a rising opioid overdose epidemic, Nevada passed legislative bills SB 459, AB 474, and AB 239 between 2015 and 2019 to reduce opioid prescriptions and, in turn, opioid-related deaths in Nevada. This paper analyzes trends in opioid prescription rates relative to legal and illegal opioid death rates from June 2015 to May 2020 in Clark and Washoe Counties. Data on opioid prescriptions was obtained from the Nevada Board of Pharmacy. Data on all opioid-related deaths was obtained from the Clark County Office of the Coroner/Medical Examiner and the Washoe County Regional Medical Examiner. Clark County and Washoe County showed similar trends (P=0.07), where AB 474 was associated with a 27.4% overall drop in prescription rates (from 68 per 1,000 people to 50 per 1,000), and it set up a trend of declining opioid prescribing rates that continued through May 2020. Prescription opioid death rates declined with prescription rates over time (P<0.01), but illicit opioid deaths rose slightly (heroin) or dramatically (fentanyl) during the same period, with a particularly notable increase during the COVID-19 Stay at Home order. In conclusion, 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 to help balance appropriate accessibility to pain management for patients with the need to limit prescription opioid deaths: (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.

Published in	American Journal of Internal Medicine (Volume 9, Issue 4)
DOI	10.11648/j.ajim.20210904.17
Page(s)	204-209
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2021. Published by Science Publishing Group

Keywords

Opioids, Opioid Related Deaths, Legislation, Nevada, SB 459, AB 474, AB 239

References

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[2]	Schmitz, R. (1985). Friedrich Wilhelm Sertürner and the discovery of morphine. Pharmacy in History, 27 (2), 61-74.
[3]	Centers for Disease Control and Prevention (2020). Opioid overdose: Understanding the epidemic. Retrieved from: https://www.cdc.gov/drugoverdose/epidemic/index.html.
[4]	Centers for Disease Control and Prevention (2018). Opioid basics. Retrieved from https://www.cdc.gov/drugoverdose/opioids/index.html.
[5]	De Leon, J. (2018). Associations between opioid-related hospitalizations and intravenous drug users (Order No. 13423851). Available from ProQuest One Academic. (2210170970). Retrieved from https://www.proquest.com/dissertations-theses/associations-between-opioid-related/docview/2210170970/se-2?accountid=28843.
[6]	Kim P. C., Yoo J. W., Cochran C. R., Park S. M., Chun S., Lee Y. J., & Shen J. J (2019). Trends and associated factors of use of opioid, heroin, and cannabis among patients for emergency department visits in Nevada: 2009-2017. Medicine (Baltimore). 98 (47): e17739. doi: 10.1097/MD.0000000000017739.
[7]	Nevada State Opioid Response (2021). Suspected Nevada drug overdose surveillance monthly report May 2021: Statewide report. Retrieved from: https://www.nvopioidresponse.org/publications-documents/.
[8]	Paul ABM, Simms L, Mahesan AA, Belanger EC. Teens, Drugs, & Vegas: Toxicological surveillance of illicit prescription and illegal drug abuse in adolescents (12-17 years) using post-mortem data in Clark County, Nevada from 2005 to 2015. Journal of Forensic and Legal Medicine, 58, 20-24. doi: 10.1016/j.jflm.2018.04.002.
[9]	Nevada State Legislature (2015) Senate Bill (S. B.) 459. Retrieved from https://www.leg.state.nv.us/app/nelis/rel/78th2015/bill/2162/Overview.
[10]	Nevada State Legislature (2017) Assembly Bill (A. B.) 474. Retrieved from https://www.leg.state.nv.us/App/NELIS/REL/79th2017/Bill/5735/Overview.
[11]	Nevada State Legislature (2019) Assembly Bill (A. B.) 239. Retrieved from https://www.leg.state.nv.us/App/NELIS/REL/80th2019/Bill/6425/Overview.
[12]	U. S. Census Bureau (2020). Nevada 2019 Population Estimates. Retrieved from: https://www.census.gov/search-results.html?searchType=web&cssp=SERP&q=nevada%20population.
[13]	Nevada Health Response (2020). Nevada Health Response COVID-19 Risk Mitigation Initiative [press release]. Retrieved from: http://gov.nv.gov/News/Emergency_Orders/2020/2020-03-12_-_COVID-19_Declaration_of_Emergency/.
[14]	Cicero T. J., Ellis M. S., Surratt H. L., & Kurtz S. P. (2014). The changing face of heroin use in the United States: A retrospective analysis of the past 50 years. JAMA Psychiatry, 71 (7), 821-826. doi: 10.1001/jamapsychiatry.2014.366.
[15]	Victor, G. A., Walker, R., Cole, J., & Logan, T. K (2017). Opioid analgesics and heroin: Examining drug misuse trends among a sample of drug treatment clients in Kentucky. International Journal of Drug Policy, 46, 1-6. doi: 10.1016/j.drugpo.2017.01.008.
[16]	Department of Justice Drug Enforcement Agency (2019). National threat assessment. Retrieved from: https://www.dea.gov/sites/default/files/2020-01/2019-NDTA-final-01-14-2020_Low_Web-DIR-007-20_2019.pdf.

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APA Style

Taylor Cornwell-Hinrichs, Cara Wyant, Cheryl Vanier, Weldon Havins, Joseph Paul Hardy. (2021). Trends in Opioid Death Rates Following Implementation of Nevada’s Opioid Prescribing Laws. American Journal of Internal Medicine, 9(4), 204-209. https://doi.org/10.11648/j.ajim.20210904.17

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ACS Style

Taylor Cornwell-Hinrichs; Cara Wyant; Cheryl Vanier; Weldon Havins; Joseph Paul Hardy. Trends in Opioid Death Rates Following Implementation of Nevada’s Opioid Prescribing Laws. Am. J. Intern. Med. 2021, 9(4), 204-209. doi: 10.11648/j.ajim.20210904.17

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AMA Style

Taylor Cornwell-Hinrichs, Cara Wyant, Cheryl Vanier, Weldon Havins, Joseph Paul Hardy. Trends in Opioid Death Rates Following Implementation of Nevada’s Opioid Prescribing Laws. Am J Intern Med. 2021;9(4):204-209. doi: 10.11648/j.ajim.20210904.17

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@article{10.11648/j.ajim.20210904.17,
  author = {Taylor Cornwell-Hinrichs and Cara Wyant and Cheryl Vanier and Weldon Havins and Joseph Paul Hardy},
  title = {Trends in Opioid Death Rates Following Implementation of Nevada’s Opioid Prescribing Laws},
  journal = {American Journal of Internal Medicine},
  volume = {9},
  number = {4},
  pages = {204-209},
  doi = {10.11648/j.ajim.20210904.17},
  url = {https://doi.org/10.11648/j.ajim.20210904.17},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajim.20210904.17},
  abstract = {In response to a rising opioid overdose epidemic, Nevada passed legislative bills SB 459, AB 474, and AB 239 between 2015 and 2019 to reduce opioid prescriptions and, in turn, opioid-related deaths in Nevada. This paper analyzes trends in opioid prescription rates relative to legal and illegal opioid death rates from June 2015 to May 2020 in Clark and Washoe Counties. Data on opioid prescriptions was obtained from the Nevada Board of Pharmacy. Data on all opioid-related deaths was obtained from the Clark County Office of the Coroner/Medical Examiner and the Washoe County Regional Medical Examiner. Clark County and Washoe County showed similar trends (P=0.07), where AB 474 was associated with a 27.4% overall drop in prescription rates (from 68 per 1,000 people to 50 per 1,000), and it set up a trend of declining opioid prescribing rates that continued through May 2020. Prescription opioid death rates declined with prescription rates over time (P<0.01), but illicit opioid deaths rose slightly (heroin) or dramatically (fentanyl) during the same period, with a particularly notable increase during the COVID-19 Stay at Home order. In conclusion, 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 to help balance appropriate accessibility to pain management for patients with the need to limit prescription opioid deaths: (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.},
 year = {2021}
}

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TY  - JOUR
T1  - Trends in Opioid Death Rates Following Implementation of Nevada’s Opioid Prescribing Laws
AU  - Taylor Cornwell-Hinrichs
AU  - Cara Wyant
AU  - Cheryl Vanier
AU  - Weldon Havins
AU  - Joseph Paul Hardy
Y1  - 2021/08/04
PY  - 2021
N1  - https://doi.org/10.11648/j.ajim.20210904.17
DO  - 10.11648/j.ajim.20210904.17
T2  - American Journal of Internal Medicine
JF  - American Journal of Internal Medicine
JO  - American Journal of Internal Medicine
SP  - 204
EP  - 209
PB  - Science Publishing Group
SN  - 2330-4324
UR  - https://doi.org/10.11648/j.ajim.20210904.17
AB  - In response to a rising opioid overdose epidemic, Nevada passed legislative bills SB 459, AB 474, and AB 239 between 2015 and 2019 to reduce opioid prescriptions and, in turn, opioid-related deaths in Nevada. This paper analyzes trends in opioid prescription rates relative to legal and illegal opioid death rates from June 2015 to May 2020 in Clark and Washoe Counties. Data on opioid prescriptions was obtained from the Nevada Board of Pharmacy. Data on all opioid-related deaths was obtained from the Clark County Office of the Coroner/Medical Examiner and the Washoe County Regional Medical Examiner. Clark County and Washoe County showed similar trends (P=0.07), where AB 474 was associated with a 27.4% overall drop in prescription rates (from 68 per 1,000 people to 50 per 1,000), and it set up a trend of declining opioid prescribing rates that continued through May 2020. Prescription opioid death rates declined with prescription rates over time (P<0.01), but illicit opioid deaths rose slightly (heroin) or dramatically (fentanyl) during the same period, with a particularly notable increase during the COVID-19 Stay at Home order. In conclusion, 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 to help balance appropriate accessibility to pain management for patients with the need to limit prescription opioid deaths: (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.
VL  - 9
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Author Information

Taylor Cornwell-Hinrichs

College of Osteopathic Medicine, Touro University Nevada, Henderson, The United States
Cara Wyant

College of Osteopathic Medicine, Touro University Nevada, Henderson, The United States
Cheryl Vanier

College of Osteopathic Medicine, Touro University Nevada, Henderson, The United States
Weldon Havins

College of Osteopathic Medicine, Touro University Nevada, Henderson, The United States
Joseph Paul Hardy

College of Osteopathic Medicine, Touro University Nevada, Henderson, The United States

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APA Style

Taylor Cornwell-Hinrichs, Cara Wyant, Cheryl Vanier, Weldon Havins, Joseph Paul Hardy. (2021). Trends in Opioid Death Rates Following Implementation of Nevada’s Opioid Prescribing Laws. American Journal of Internal Medicine, 9(4), 204-209. https://doi.org/10.11648/j.ajim.20210904.17

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ACS Style

Taylor Cornwell-Hinrichs; Cara Wyant; Cheryl Vanier; Weldon Havins; Joseph Paul Hardy. Trends in Opioid Death Rates Following Implementation of Nevada’s Opioid Prescribing Laws. Am. J. Intern. Med. 2021, 9(4), 204-209. doi: 10.11648/j.ajim.20210904.17

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AMA Style

Taylor Cornwell-Hinrichs, Cara Wyant, Cheryl Vanier, Weldon Havins, Joseph Paul Hardy. Trends in Opioid Death Rates Following Implementation of Nevada’s Opioid Prescribing Laws. Am J Intern Med. 2021;9(4):204-209. doi: 10.11648/j.ajim.20210904.17

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@article{10.11648/j.ajim.20210904.17,
  author = {Taylor Cornwell-Hinrichs and Cara Wyant and Cheryl Vanier and Weldon Havins and Joseph Paul Hardy},
  title = {Trends in Opioid Death Rates Following Implementation of Nevada’s Opioid Prescribing Laws},
  journal = {American Journal of Internal Medicine},
  volume = {9},
  number = {4},
  pages = {204-209},
  doi = {10.11648/j.ajim.20210904.17},
  url = {https://doi.org/10.11648/j.ajim.20210904.17},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajim.20210904.17},
  abstract = {In response to a rising opioid overdose epidemic, Nevada passed legislative bills SB 459, AB 474, and AB 239 between 2015 and 2019 to reduce opioid prescriptions and, in turn, opioid-related deaths in Nevada. This paper analyzes trends in opioid prescription rates relative to legal and illegal opioid death rates from June 2015 to May 2020 in Clark and Washoe Counties. Data on opioid prescriptions was obtained from the Nevada Board of Pharmacy. Data on all opioid-related deaths was obtained from the Clark County Office of the Coroner/Medical Examiner and the Washoe County Regional Medical Examiner. Clark County and Washoe County showed similar trends (P=0.07), where AB 474 was associated with a 27.4% overall drop in prescription rates (from 68 per 1,000 people to 50 per 1,000), and it set up a trend of declining opioid prescribing rates that continued through May 2020. Prescription opioid death rates declined with prescription rates over time (P<0.01), but illicit opioid deaths rose slightly (heroin) or dramatically (fentanyl) during the same period, with a particularly notable increase during the COVID-19 Stay at Home order. In conclusion, 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 to help balance appropriate accessibility to pain management for patients with the need to limit prescription opioid deaths: (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.},
 year = {2021}
}

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TY  - JOUR
T1  - Trends in Opioid Death Rates Following Implementation of Nevada’s Opioid Prescribing Laws
AU  - Taylor Cornwell-Hinrichs
AU  - Cara Wyant
AU  - Cheryl Vanier
AU  - Weldon Havins
AU  - Joseph Paul Hardy
Y1  - 2021/08/04
PY  - 2021
N1  - https://doi.org/10.11648/j.ajim.20210904.17
DO  - 10.11648/j.ajim.20210904.17
T2  - American Journal of Internal Medicine
JF  - American Journal of Internal Medicine
JO  - American Journal of Internal Medicine
SP  - 204
EP  - 209
PB  - Science Publishing Group
SN  - 2330-4324
UR  - https://doi.org/10.11648/j.ajim.20210904.17
AB  - In response to a rising opioid overdose epidemic, Nevada passed legislative bills SB 459, AB 474, and AB 239 between 2015 and 2019 to reduce opioid prescriptions and, in turn, opioid-related deaths in Nevada. This paper analyzes trends in opioid prescription rates relative to legal and illegal opioid death rates from June 2015 to May 2020 in Clark and Washoe Counties. Data on opioid prescriptions was obtained from the Nevada Board of Pharmacy. Data on all opioid-related deaths was obtained from the Clark County Office of the Coroner/Medical Examiner and the Washoe County Regional Medical Examiner. Clark County and Washoe County showed similar trends (P=0.07), where AB 474 was associated with a 27.4% overall drop in prescription rates (from 68 per 1,000 people to 50 per 1,000), and it set up a trend of declining opioid prescribing rates that continued through May 2020. Prescription opioid death rates declined with prescription rates over time (P<0.01), but illicit opioid deaths rose slightly (heroin) or dramatically (fentanyl) during the same period, with a particularly notable increase during the COVID-19 Stay at Home order. In conclusion, 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 to help balance appropriate accessibility to pain management for patients with the need to limit prescription opioid deaths: (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.
VL  - 9
IS  - 4
ER  -

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