An Analysis of the Opioid Crisis in Nevada

Abstract

This study examines the Nevada State Prescription Drug Monitoring Program (PDMP) data from 2011 to 2017. While much of the research surrounding the National Opioid crisis focuses on overdose fatalities, this study seeks to examine the more understudied aspect of potential misuse, abuse and diversion in the form of high pill and morphine milligram equivalents (MMEs) of these opioid prescriptions in the State of Nevada. High quantities of pills and MMEs are a proxy measure for the potential danger of prescription abuse, misuse, and diversion of opioid pills in the Nevada community. Problem indicators for the misuse of opioid pill prescriptions are defined using prescription and patient level information and include: doctor shopping and pharmacy shopping type behavior, the presence of a combination of an opioid and benzodiazepine within a one-month period, the presence of an opioid, benzodiazepine, and muscle relaxer within a one-month period, receiving prescriptions for more than seven consecutive months within a year, receiving prescriptions that exceeded 90 daily MMEs, payment for a prescription in cash, and using both cash and insurance to pay for the same type of opioid medication within the same year. Outcome variables are defined by high rates of total pills, the number of pills per day, and the daily milligram morphine equivalents (MMEs), as these measures of misuse are the most readily available in terms of the Nevada State PDMP data. Independent sample t-tests and one-way ANOVAs were conducted, resulting in statistically significant differences the total number of pills, number of pills per day, and the daily MME dosages of patients who had a co-occurrence of problem indicators as well as an examination of differences between each indicator. Patients who have a higher rate of co-occurrences of indicators received more opioid pills, have higher pills per day, and higher MME dosages. Patients who score on an indicator have higher rates of total pills, pills per day, and daily MME dosages, when compared to patients who have no indicators. The largest differences found among patients who receive an opioid and a benzodiazepine within one month, and an opioid, benzodiazepine and carisoprodol within one month, compared to patients who have never received these prescription combinations. One exception with respects to the indicators is that patients who paid for their opioid prescriptions 90 percent or more of the time in cash had lower total pill counts, pills per day counts, and daily MME dosages, compared to patients who did not pay in cash. Geographic locations were also examined in terms of urban south, urban north, rural south, and rural north areas of the State of Nevada for the outcome variables of total pill counts, the number of pills per day, and the daily MME dosages. Results reveal differences in the three measures of opioid pill misuse between patients who live in the four geographic locations.