Do naloxone access laws increase outpatient naloxone prescriptions? Evidence from Medicaid
Do naloxone access laws increase outpatient naloxone prescriptions? Evidence from Medicaid
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DOI：
10.1016/j.drugalcdep.2018.05.014
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发表时间：
2018-09-01
影响因子：
4.2
通讯作者：
Davis, Corey S.
中科院分区：
文献类型：
--
作者：
Gertner, Alex K.;Domino, Marisa Elena;Davis, Corey S.
背景：纳洛酮是一种能快速有效逆转阿片类药物过量的处方药。医疗补助是物质使用障碍服务的主要支付者，医疗补助受益人经历了特别高的阿片类药物过量使用率。随着阿片类药物过量比率的急剧上升，每个州都修改了法律，使纳洛酮更容易获得。本文的目的是确定纳洛酮获取法不同条款的实施是否导致由医疗补助资助的纳洛酮配药增加。方法：我们回顾了2007-2016年间各州通过的纳洛酮立法。我们使用医疗补助州药物利用数据集单独和作为一个整体检查了不同类型的州纳洛酮获取法条款对2007年至2016年医疗补助报销的门诊纳洛酮处方数量的影响。我们在我们的模型中加入了州级协变量，这些协变量可能与纳洛酮在医疗补助中的使用以及纳洛酮准入法律的通过有关。结果：我们发现，任何纳洛酮法律的存在都与通过医疗补助报销的门诊纳洛酮的增加显著相关。包含常规条款的法律与各型号纳洛酮配药的增加最为一致。常规条款导致每个州季度平均增加约33张纳洛酮处方，相当于每个州季度平均纳洛酮处方数量的74%。结论：纳洛酮获取法，特别是那些有常规条款的法律，似乎是增加医疗补助受益人获得纳洛酮的有效政策方法。
Background: Naloxone is a prescription medication that can quickly and effectively reverse opioid overdose. Medicaid is a major payer of substance use disorder services, and Medicaid beneficiaries experience especially high rates of opioid overdose. As opioid overdose rates have risen sharply, every state has modified its laws to make naloxone easier to access. The aim of this paper is to determine whether implementation of different provisions of naloxone access laws led to increased naloxone dispensing financed by Medicaid.Methods: We reviewed naloxone legislation passed by every state between 2007 and 2016. We used the Medicaid State Drug Utilization dataset to examine the effect of different types of state naloxone access law provisions, separately and as a whole, on the number of outpatient naloxone prescriptions reimbursed by Medicaid from 2007 to 2016. We included state-level covariates in our models that may be correlated with naloxone utilization in Medicaid and passage of naloxone access laws.Results: We found that the presence of any naloxone law was significantly associated with increases in outpatient naloxone reimbursed through Medicaid. Laws containing standing order provisions were most consistently associated with increases in naloxone dispensing across models. Standing order provisions led on average to an increase of approximately 33 naloxone prescriptions per state-quarter, which is equivalent to 74% of the average number of naloxone prescriptions per state-quarter.Conclusions: Naloxone access laws, particularly those with standing order provisions, appear to be an effective policy approach to increasing naloxone access among Medicaid beneficiaries.