Prescription Drug Monitoring Programs and Opioid Overdoses Exploring Sources of Heterogeneity
Prescription Drug Monitoring Programs and Opioid Overdoses Exploring Sources of Heterogeneity
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DOI：
10.1097/ede.0000000000000950
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发表时间：
2019-03-01
期刊：
影响因子：
5.4
通讯作者：
Cerda, Magdalena
中科院分区：
文献类型：
--
作者：
Castillo-Carniglia, Alvaro;Ponicki, William R.;Cerda, Magdalena
背景：处方药监测计划旨在减少处方阿片类药物的危害；然而，人们对哪些人群从这些计划中受益最多却知之甚少。我们调查了在线处方药监测计划的实施与处方阿片类药物和海洛因过量相关的住院率之间的关系如何随时间变化，以及不同县的贫困和失业水平以及阿片类药物的医疗获取水平之间的关系。方法：生态县级时空研究，包括 2001-2014 年 16 个州的 990 个县。我们使用贝叶斯分层泊松模型对过量用药计数进行建模。我们将阿片类药物的医疗可及性定义为县级非癌性疼痛病症的出院率。结果：2010-2014 年，在线处方药监测计划与处方阿片类药物相关住院率较低相关（2014 年比率= 0.74；95% 可信区间= 0.69，0.80）。在线处方药监测项目与海洛因相关住院之间的关联也呈负相关，但在以后几年往往会增加。非癌症疼痛发生率较低的县，处方阿片类药物过量减少幅度较小，海洛因过量增加较快。不同县的贫困和失业水平没有差异。结论：在实施在线处方药监测计划后，非癌症疼痛水平较低的地区处方阿片类药物过量减少幅度最小，海洛因过量增加较快。我们的结果与以下假设一致：处方药监测计划在人们可能通过医疗提供者获得阿片类药物的地区最有效。
Background: Prescription drug monitoring program are designed to reduce harms from prescription opioids; however, little is known about what populations benefit the most from these programs. We investigated how the relation between implementation of online prescription drug monitoring programs and rates of hospitalizations related to prescription opioids and heroin overdose changed over time, and varied across county levels of poverty and unemployment, and levels of medical access to opioids.Methods: Ecologic county-level, spatiotemporal study, including 990 counties within 16 states, in 2001-2014. We modeled overdose counts using Bayesian hierarchical Poisson models. We defined medical access to opioids as the county-level rate of hospital discharges for noncancer pain conditions.Results: In 2010-2014, online prescription drug monitoring programs were associated with lower rates of prescription opioid-related hospitalizations (rate ratio 2014 = 0.74; 95% credible interval = 0.69, 0.80). The association between online prescription drug monitoring programs and heroin-related hospitalization was also negative but tended to increase in later years. Counties with lower rates of noncancer pain conditions experienced a lower decrease in prescription opioid overdose and a faster increase in heroin overdoses. No differences were observed across different county levels of poverty and unemployment.Conclusions: Areas with lower levels of noncancer pain conditions experienced the smallest decrease in prescription opioid overdose and the faster increase in heroin overdose following implementation of online prescription drug monitoring programs. Our results are consistent with the hypothesis that prescription drug monitoring programs are most effective in areas where people are likely to access opioids through medical providers.