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.