Year of Publication



Public Health

Date Available


Degree Name

Dr. of Public Health (Dr.P.H.)

Committee Chair

Dr. Rick Ingram

Committee Member

Dr. Chris Delcher

Committee Member

Dr. Dana Quesinberry


The opioid epidemic has impacted few other places more than the state of Kentucky. In 2018, data from the Centers of Disease Control and Prevention (CDC) and the National Institute on Drug Abuse (NIDA) ranked Kentucky as being in the top ten for rate of drug overdose deaths and opioid-involved overdose deaths per 100,000 persons.1,2 These rankings exist even though prescription opioid dispensing rates have fallen from 102.6 per 100 persons in 2015 to 72.3 per 100 persons in 2019.3 Aligning with this trend, while research shows this problem began with prescription opioids in the late 1990’s, it has transformed over time into being a public health crisis on both the licit and illicit front due to misuse, diversion, opioid use disorders (OUD), and the infectious diseases that accompany injection drug use.4 Synthetic opioids, such as fentanyl and fentanyl analogues, are now the main driver of opioid related deaths and have caused a recent uptick in overdose deaths both nationwide and in Kentucky, and the state Office of Drug Control Policy (ODCP) presented that they were involved in more than half of all overdose deaths in 2018.5,6

Over the course of the last decade, Kentucky has enacted and implemented a variety of healthcare policy and regulation changes aimed to limit opioid prescribing and reduce the negative outcomes that may result from OUD and opioid overdose. Some of these changes include requiring prescribers to obtain medical histories, query the prescription drug monitoring program (PDMP), known in Kentucky as Kentucky All Schedule Prescription Electronic Reporting (KASPER), make treatment plans before dispensing any Schedule II or Schedule III substances containing hydrocodone, and to complete mandatory continuing medical education (CME).7 One important recent policy change was the implementation of House Bill 333 (HB333) in 2017, which updated Kentucky Revised Statute (KRS) 218A.205 to limit prescriptions of Schedule II opioids to a 3-day supply when being used to treat acute pain.8 Due to the changing epidemiology of this disease and its public health implications we must explore whether this policy change to limit opioid prescribing has had the intended impact of reducing unnecessary opioid prescribing and decreasing opioid related healthcare utilization. While thousands of papers on opioid prescribing, use, and abuse have been written, with over 140 of them being policy related, very few have been focused on Kentucky alone.9 The manuscripts written for this capstone aim to answer this question by analyzing two state-level data sources which include: the IBM Marketscan commercial claims and encounters research database and the Kentucky hospital inpatient discharge and Emergency Department (ED) and outpatient services data, also known as the Healthcare Cost Utilization Project (HCUP) data, both prior to and after the updates to KRS 218A.205 went into effect to determine whether this new policy was associated with a change in opioid prescribing and opioid related healthcare utilization.

Results of this study provide evidence that this policy had little to no effect on the average days’ supply of opioids or the rate of opioid prescribing among the privately insured. However, results did demonstrate that the law had an impact on both opioid poisoning and OUD diagnoses in some settings, but this policy must be accompanied by other prevention and treatment efforts to most effectively combat the opioid epidemic as it continues to evolve.

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