Association Between State Opioid Prescribing Cap Laws and Receipt of Opioid Prescriptions Among Children and Adolescents.
Association Between State Opioid Prescribing Cap Laws and Receipt of Opioid Prescriptions Among Children and Adolescents.
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DOI：
10.1001/jamahealthforum.2022.2461
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发表时间：
2022-08
期刊：
影响因子：
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通讯作者：
McGinty, Emma E
中科院分区：
文献类型：
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作者：
Stone, Elizabeth M;Tormohlen, Kayla N;McCourt, Alexander D;Schmid, Ian;Stuart, Elizabeth A;Davis, Corey S;Bicket, Mark C;McGinty, Emma E
限制阿片类药物处方剂量和/或持续时间的州法律（阿片类药物处方上限法）与儿童和青少年接受阿片类药物处方之间有何关联？在这项对美国482118名儿童和青少年的横断面研究中，考虑到交错政策采用的差异分析发现，州阿片类药物处方上限法律与接受任何阿片类药物处方或青少年阿片类药物处方的数量，剂量或持续时间之间没有统计学显著相关性。这项研究发现，州阿片类药物处方上限法律与儿童和青少年接受阿片类药物处方之间没有关联，这表明需要替代策略，例如为青少年量身定制的阿片类药物处方指南。高剂量和长期阿片类药物处方在儿童和青少年中仍然相对常见，但对限制阿片类药物处方剂量和/或持续时间的州法律（称为阿片类药物处方上限法）与这一群体的阿片类药物处方之间的关联研究不足。研究国家阿片类药物处方上限法律与儿童和青少年接受阿片类药物处方之间的关联。这项重复的横断面研究使用了差异中的差异方法，考虑了交错的政策采用，以评估2013年1月1日至2019年12月31日期间美国各州阿片类药物处方上限法律与儿童和青少年接受阿片类药物处方的相关性。分析于二零二一年三月二十二日至十二月十五日期间进行。数据来自OptumLabs数据仓库，一个国家商业保险索赔数据库。该分析包括482118名0至17岁的商业保险儿童和青少年，他们在2013年至2019年期间连续投保了一年。在连续入组的每一年纳入个体;他们不需要在整个7年研究期间入组。有任何癌症诊断的人被排除在分析之外。在2017年1月1日至2019年7月1日期间实施州阿片类药物处方上限法。该日期范围允许对封顶前和封顶后数据的相同年份进行分析。关注的结局包括接受任何阿片类药物处方，以及在至少接受1次阿片类药物处方的患者中，阿片类药物处方的平均数量、每日平均吗啡毫克当量（MME）和平均供应天数。在482118名儿童和青少年中（754368人-年的数据汇总到州年度水平），245178人（50.9%）为男性，样本中第一年的平均（SD）年龄为9.8（4.8）岁（未收集种族和民族数据作为该数据集的一部分，该数据集来自保险账单索赔）。总体而言，10659名儿童和青少年（2.2%）在研究期间接受了至少1次阿片类药物处方。在至少有1个处方的人中，平均（SD）填充阿片类药物处方数为每人每年1.2（0.8）。在州阿片类药物处方上限法律和任何结果之间没有发现统计学显著相关性。在阿片类药物处方上限法律实施后，观察到接受任何阿片类药物处方的青少年比例下降了-0.001（95%CI，-0.005至0.002）个百分点。此外，在实施上限法律后，发现高剂量阿片类药物处方（每天>50次MME）和长期阿片类药物处方（>7天供应）分别下降了-0.01（95% CI，-0.10至0.09）和-0.02（95% CI，-0.12至0.08）。在这项横断面研究中，未观察到国家阿片类药物处方上限法律与儿童和青少年接受阿片类药物处方之间存在关联。需要替代策略，例如为青少年量身定制的阿片类药物处方指南。这项横断面研究评估了限制阿片类药物处方剂量和/或持续时间的州法律与美国儿童和青少年接受阿片类药物处方之间的关联。
What is the association between state laws limiting the dose and/or duration of opioid prescriptions (opioid prescribing cap laws) and the receipt of opioid prescriptions among children and adolescents? In this cross-sectional study of 482 118 children and adolescents in the US, a difference-in-differences analysis accounting for staggered policy adoption found no statistically significant association between state opioid prescribing cap laws and the receipt of any opioid prescription or the number, dose, or duration of opioid prescription fills for youths. This study found no association between state opioid prescribing cap laws and the receipt of opioid prescriptions among children and adolescents, suggesting that alternative strategies, such as opioid prescribing guidelines tailored to youths, are needed. High-dose and long-duration opioid prescriptions remain relatively common among children and adolescents, but there is insufficient research on the association of state laws limiting the dose and/or duration of opioid prescriptions (referred to as opioid prescribing cap laws) with opioid prescribing for this group. To examine the association between state opioid prescribing cap laws and the receipt of opioid prescriptions among children and adolescents. This repeated cross-sectional study used a difference-in-differences approach accounting for staggered policy adoption to assess the association of state opioid prescribing cap laws in the US from January 1, 2013, to December 31, 2019, with receipt of opioid prescriptions among children and adolescents. Analyses were conducted between March 22 and December 15, 2021. Data were obtained from the OptumLabs Data Warehouse, a national commercial insurance claims database. The analysis included 482 118 commercially insured children and adolescents aged 0 to 17 years with full calendar-year continuous insurance enrollment between 2013 and 2019. Individuals were included for every year in which they were continuously enrolled; they did not need to be enrolled for the entire 7-year study period. Those with any cancer diagnosis were excluded from analysis. Implementation of a state opioid prescribing cap law between January 1, 2017, and July 1, 2019. This date range allowed analysis of the same number years for both pre-cap and post-cap data. Outcomes of interest included receipt of any opioid prescription and, among those with at least 1 opioid prescription, the mean number of opioid prescriptions, mean morphine milligram equivalents (MMEs) per day, and mean days’ supply. Among 482 118 children and adolescents (754 368 person-years of data aggregated to the state-year level), 245 178 (50.9%) were male, with a mean (SD) age of 9.8 (4.8) years at the first year included in the sample (data on race and ethnicity were not collected as part of this data set, which was obtained from insurance billing claims). Overall, 10 659 children and adolescents (2.2%) received at least 1 opioid prescription during the study period. Among those with at least 1 prescription, the mean (SD) number of filled opioid prescriptions was 1.2 (0.8) per person per year. No statistically significant association was found between state opioid prescribing cap laws and any outcome. After opioid prescribing cap laws were implemented, a −0.001 (95% CI, −0.005 to 0.002) percentage point decrease in the proportion of youths receiving any opioid prescription was observed. In addition, percentage point decreases of −0.01 (95% CI, −0.10 to 0.09) in high-dose opioid prescriptions (>50 MMEs per day) and −0.02 (95% CI, −0.12 to 0.08) in long-duration opioid prescriptions (>7 days’ supply) were found after cap laws were implemented. In this cross-sectional study, no association was observed between state opioid prescribing cap laws and the receipt of opioid prescriptions among children and adolescents. Alternative strategies, such as opioid prescribing guidelines tailored to youths, are needed. This cross-sectional study assesses the association between state laws limiting the dose and/or duration of opioid prescriptions and the receipt of opioid prescriptions among children and adolescents in the US.