Effects of opioid prescribing laws on drug use in trauma patients

Abstract

Background: On November 1st, 2018 Oklahoma Bill 1446 went into effect: limiting the total days of initial opioid prescriptions, follow up opioid prescriptions, chronic opioid prescriptions, mandating prescription monitoring program checking, prescribing opioids to minors, and the need to establish drug contracts and urine drug screening of your patients taking opioids. We believe that with the new rigid opioid prescribing laws in Oklahoma and difficult access to prescription pain medications, abandoned pain patients will turn to illicit drugs because of cheap cost and ease of access. We are assessing the illicit drug usage outcomes after a prescribing law going into effect in patients aged 18-65 reported in level II trauma registries.

Methods: Data base search of all patients admitted to the trauma service at a level II trauma center from November 1st 2017 to November 1st 2019. We will assess de-identified patient data regarding injury severity score, mechanism of injury, urine drugs screen results, time spent in hospital and emergency department, prehospital prescriptions, emergency department medications, BMI, age, gender, mechanism of injury, surgical services, type and number of procedures performed, and disposition.

Results: Currently we are building the search based on the above criteria of the trauma registry. We expect the results to demonstrate that illicit drug usage will rise in trauma patients after Bill 1446 went into effect due to decreased access of prescription opioids. Based on our current study design urine drug screen for opioids alone will not be enough information because many patients transferred into the trauma center may have received prescription opioids prior to arrival at the hospital via EMS or transferring facility. We expect a rise in urine drug screen's positive for illicit drugs. We also expect patients that did test positive for illicit drugs to have longer hospital admissions, higher injury severity scores, more surgeries/procedures required, and worse mechanism of injuries.

Conclusions: We believe that with the new rigid opioid prescribing laws in Oklahoma and difficult access to prescription pain medications, many patients will turn to illicit drugs after Bill 1446 went into effect. Our study is aimed to determine how the Opioid Prescribing Laws in Oklahoma affected illicit drug use in trauma patients. The primary goal for implementing the Opioid Prescribing Laws was to combat the Opioid Epidemic across the United States, however we believe law makers may have been too stringent on the implementation of the Opioid Prescribing Laws. We believe our study will help guide politician and law makers in the future when assessing the possible secondary effects of these drugs laws.