Opioids for the Masses: Welfare Tradeoffs in the Regulation of Narcotic Pain Medications
Opioids for the Masses: Welfare Tradeoffs in the Regulation of Narcotic Pain Medications
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大众阿片类药物：麻醉止痛药监管中的福利权衡
DOI：
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发表时间：
2016
期刊：
影响因子：
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通讯作者：
A. Kilby
中科院分区：
文献类型：
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作者：
A. Kilby
自1999年以来，使用处方阿片类止痛药来管理疼痛的人数增加了四倍，因为医疗指南越来越强调，为了达到可接受的护理标准，需要进行适当的疼痛管理。然而，随之而来的阿片类药物滥用、成瘾、过量和死亡的迅速增加导致最近采取措施打击阿片类药物处方。本文揭示了公共政策的权衡，减少医疗阿片类药物的供应，通过调查他们的健康，劳动和福利的后果。我利用州一级的变化，在引进处方监测计划（PMP）的法律，并利用几个丰富的数据源，记录PMP减少阿片类药物的分布，并实现了一个关键的政策目标，减少阿片类药物过量死亡约12%。我还发现，这些政策造成了大量成本，包括医院环境中的疼痛增加，受伤和残疾人的缺勤天数增加，以及替代更昂贵的医疗保健。粗略的信封福利计算表明，监管带来的福利损失和收益在同一数量级上，每年约有121亿美元的住院和门诊医疗支出增加的成本加上工资损失，而每年从阿片类药物和海洛因过量拯救生命的收益为73亿美元。马萨诸塞州经济系。电子邮件：akilby@mit.edu。我非常感谢乔恩·格鲁伯、艾米·芬克尔斯坦和海蒂威廉姆斯在整个项目中提供的建议、指导和支持。我还要感谢亚历克斯·巴蒂克、恩里科·坎托尼、约瑟夫·道尔、卢多维卡·加泽、萨利·哈德逊、马尼沙·帕迪、乔纳森·佩特昆、吉姆·波特巴、布伦丹·普莱斯、奥蒂斯·里德、娜塔莉亚·里戈尔、阿什什·谢诺伊、埃文·史密斯、梅勒妮·沃瑟曼以及麻省理工学院公共财政和夏季应用微型午餐会的参与者，感谢他们提供的有益反馈。资金支持是感谢国家科学基金会研究生奖学金，和国家老龄化研究所博士前奖学金。
Use of prescription opioid pain relievers to manage pain has increased fourfold since 1999, as medical guidelines have increasingly emphasized that appropriate pain management is required for an acceptable standard of care. However, a concomitant rapid rise in opioid abuse, addiction, overdose, and death has led to recent efforts to crack down on opioid prescribing. This paper sheds light on the tradeoffs of public policies that reduce the supply of medical opioids by investigating their health, labor, and welfare ramifications. I exploit state-level variation in the introduction of Prescription Monitoring Program (PMP) laws, and make use of several rich data sources, documenting that PMPs reduce the distribution of opioids, and achieve a key policy goal by reducing opioid overdose deaths by about 12%. I also find substantial costs resulting from these policies, including increased pain in the hospital setting, more missed days for injured and disabled individuals, and substitution towards more expensive medical care. A rough back-of-the-envelope welfare calculation suggests the welfare losses and gains from regulation are on the same order of magnitude approximately $12.1 billion per year in increased costs from inpatient and outpatient medical spending plus lost wages, compared to $7.3 billion per year in benefits from lives saved from opioid and heroin overdose. ∗Department of Economics, Massachusetts Institute of Technology. Email: akilby@mit.edu. I am grateful to Jon Gruber, Amy Finkelstein, and Heidi Williams for their advice, guidance and support throughout this project. I also thank Alex Bartik, Enrico Cantoni, Joseph Doyle, Ludovica Gazze, Sally Hudson, Manisha Padi, Jonathan Petkun, Jim Poterba, Brendan Price, Otis Reid, Natalia Rigol, Ashish Shenoy, Evann Smith, Melanie Wasserman, and the MIT Public Finance and Summer Applied Micro Lunch participants, for their helpful feedback. Funding support is gratefully acknowledged from the National Science Foundation Graduate Research Fellowship, and the National Institute on Aging Pre-Doctoral Fellowship.
阿片类药物和慢性疼痛的治疗：争议，当前状态和未来方向。
影响因子：
2.3
作者：
Rosenblum A;Marsch LA;Joseph H;Portenoy RK
通讯作者：
Portenoy RK