Do prescription drug monitoring programs encourage prescription - or illicit - opioid abuse?
Do prescription drug monitoring programs encourage prescription - or illicit - opioid abuse?
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DOI：
10.1080/08897077.2019.1695707
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发表时间：
2019-12-09
期刊：
影响因子：
3.5
通讯作者：
Whitacre, Brian
中科院分区：
文献类型：
--
作者：
Meadowcroft, Devon;Whitacre, Brian
背景：处方药监测计划 (PDMP) 是各州可以用来打击其管辖范围内处方阿片类药物滥用的工具。然而，由于 PDMP 使处方阿片类药物更难获得，这些计划可能会产生意想不到的后果，即增加与非法阿片类药物相关的死亡人数。方法：本研究使用固定效应模型来估计 1999 年至 2016 年间 PDMP 监管强度与处方阿片类药物和海洛因相关死亡的关系。PDMP 监管强度是通过使用多重对应分析 (MCA) 创建分数来衡量的。其他模型用二元指标取代 MCA 评分，以表明是否存在一项特定法规，要求医生在开具阿片类药物处方之前访问该系统。结果：结果表明，PDMP 强度的连续测量通常与处方阿片类药物或海洛因相关的死亡率无关。然而，一个模型确实表明 PDMP 分数与海洛因相关死亡率呈正相关。使用二元强制访问变量的模型显示与处方阿片类药物和海洛因死亡呈强烈正相关。结论：这项研究支持这样的理论，即更严格的州 PDMP 与海洛因相关死亡率更高有关，这可能是由于处方阿片类药物供应量的减少所致。
Background: Prescription drug monitoring programs (PDMPs) are tools that states can use to fight prescription opioid misuse within their jurisdiction. However, because PDMPs make prescription opioids more difficult to access, these programs may have the unintended consequence of increasing deaths related to illicit opioids. Methods: This study uses fixed effects models to estimate how PDMP regulatory strength is associated with both prescription opioid- and heroin-related deaths between 1999 and 2016. PDMP regulatory strength is measured by creating a score using multiple correspondence analysis (MCA). Additional models replace the MCA score with a binary indicator for the presence of one particular regulation requiring physicians to access the system before writing opioid prescriptions. Results: Results show that continuous measures of PDMP strength are not generally associated with prescription opioid- or heroin-related death rates. Yet, one model does show that PDMP scores are positively associated with the heroin-related death rate. The models using the binary mandatory access variable show a strong positive association with both prescription opioid and heroin deaths. Conclusions: This study supports the theory that more stringent state PDMPs are associated with higher rates of heroin-related deaths, potentially due to decreases in prescription opioid availability.