Purpose In response to the opioid epidemic, West Virginia (WV) passed Senate Bill 437 (SB437). This omnibus legislation included measures related to the definition and governance of chronic pain clinics, continuing education requirements related to opioid prescribing, and changes to the prescription drug monitoring program. This analysis assesses the impact of SB437 on opioid-related mortality in WV.
Methods All-manner, drug-related resident deaths occurring in WV 2001–2015 and mid-year population estimates from the US Census, were utilised. An interrupted time series analysis compared monthly drug-related mortality rates by type [prescription and/or illicit (heroin and all fentanyl) opioids and non-opioid drugs], pre- and post-enactment of SB437 (June 2012). Level- and slope-change models were fit using segmented quasi-Poisson regression, controlling for seasonal effects.
Results Prior to SB437, the mean number of monthly opioid-related deaths was 27.8 (1.52 deaths per 100,000), with an average monthly increase of 1%. When SB437 was enacted, a significant step decrease in any-prescription-opioid-related mortality (RR=0.69, 95% CI: 0.62, 0.76) occurred, while no step change was observed for any-illicit-opioid-related mortality (RR=1.04, 95% CI: 0.83, 1.30). The annual increase in any-prescription-opioid-related mortality ceased after SB437 (pre-implementation RR=1.12, 95% CI: 1.10, 1.13; post-implementation RR=1.04, 95% CI: 0.99, 1.09); whereas, the annual increase in any-illicit-opioid-related mortality became larger (pre-implementation RR=1.11, 95% CI: 1.09, 1.14; post-implementation RR=1.38, 95% CI: 1.28, 1.48). No step (RR=1.01, 95% CI: 0.99, 1.03) or trend changes (RR=1.01, 95% CI: 0.84, 1.21) were observed for non-opioid-drug-related mortality.
Conclusions These findings suggest SB437 impacted opioid-related mortality, though differently by opioid type. While prescription-opioid-related mortality declined and levelled off after SB437 (rather than exhibiting sustained decline), illicit-opioid-related mortality accelerated.
Significance The shift in the type of opioid sustaining the increase in mortality suggests different approaches ‘“ from those applied to prescription opioids ‘“ are needed to mitigate risk of fatal opioid overdose.
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