Systematic Evaluation of State Policy Interventions Targeting the US Opioid Epidemic, 2007-2018.
Systematic Evaluation of State Policy Interventions Targeting the US Opioid Epidemic, 2007-2018.
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DOI：
10.1001/jamanetworkopen.2020.36687
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发表时间：
2021-02-01
影响因子：
13.8
通讯作者：
Perry BL
中科院分区：
文献类型：
--
作者：
Lee B;Zhao W;Yang KC;Ahn YY;Perry BL
这项横断面研究评估了2007至2018年间实施的国家药物政策，以确定它们是否与阿片类药物滥用、阿片类药物使用障碍和药物过量死亡率的变化有关。美国国家药物政策是否与阿片类药物滥用、阿片类药物使用障碍和药物过量死亡率的差异有关？在这项对2007至2018年间美国2300万商业保险患者的州级药物过量死亡率数据和索赔数据的横断面研究中，州政策与处方阿片类药物滥用的已知指标以及处方阿片类药物过量死亡的减少以及阿片类药物使用障碍、药物过量和非法药物导致的药物过量死亡的诊断增加有关。尽管现有的国家一级药物政策与处方阿片类药物滥用的减少有关，但这些政策可能产生了意想不到的后果，激励那些有阿片类药物使用障碍的人改用替代非法物质，导致更高的过量死亡率。为了应对美国阿片类药物过量死亡人数的增加，许多州最近实施了控制供应和减少伤害的政策措施。到目前为止，尚未进行考虑全面政策情况的最新政策评价。评估美国6项州级药物政策，以确定它们是否与处方阿片类药物滥用指标的减少、阿片类药物使用障碍和过量使用的流行率、药物辅助治疗(MAT)的处方以及药物过量死亡有关。这项横断面研究使用了从国家生命统计系统获得的50个州的药物过量死亡率数据，并声称2007年至2018年期间美国2300万商业保险患者的数据。对阿片类药物流行的6项国家级政策实施前后处方类阿片类药物滥用、阿片类药物使用障碍和过量诊断、MAT处方、药物过量死亡等指标进行面板配对差异分析。随机效应荟萃分析模型被用来总结每个政策和结果对随时间变化的相关性。数据分析是在2020年7月12日进行的。为解决阿片类药物过量死亡增加问题而进行的州一级药物政策变化包括获得处方药监测计划(PDMP)、强制性PDMP、疼痛诊所法、处方限制法、纳洛酮获取法和好心人法。感兴趣的结果是药物过量导致的季度州一级死亡率、处方阿片类药物滥用和医生购物的已知指标、MAT以及药物过量和阿片类药物使用障碍的流行率。这项对2007年至2018年间美国2,300万商业保险患者(12582378名女性患者(55.1%；平均[SD]年龄，45.9[19.9]岁)的药物过量死亡率数据和保险索赔数据的横断面研究发现，强制性PDMP与服用阿片类药物的患者比例的减少(−0.729%；95%CI，−1.011%至−0.447%)相关，并与阿片类药物索赔重叠(−0.027%；95%CI，−0.038%至−0.017%)，每日吗啡相当于90毫克以上(−0.095%；95%CI，−0.150%至−0.041%)，以及吸毒者(−0.002%；95%CI，−0.003%至−0.001%)。在强制性的PDMPs(0.015%；95%CI，0.002%至0.028%)、疼痛临床法律(0.013%，95%CI，0.005%-0.021%)和处方限制法(0.034%，95%CI，0.020%至0.049%)颁布后，接受MAT的患者比例增加。强制性PDMP与因天然阿片类药物(每3亿人−518.5[95%CI，−728.5至−308.5])和美沙酮(−122.7[95%CI，−207.5至−37.8]每3亿人)过量死亡人数的减少有关。处方药监测项目准入政策显示了类似的结果，尽管这些政策也与合成阿片类药物(每3亿人380.3[95%CI，149.6-610.8])和可卡因(每3亿人103.7[95%CI，28.0-179.5])造成的过量死亡有关。除了处方限制法与合成阿片类药物死亡之间的负关联(每3亿人−723.9[95%CI，−1419.7至−28.1])，其他政策与过量死亡增加有关，特别是与合成阿片类药物和海洛因等非处方类阿片类药物有关的死亡。这包括纳洛酮使用法与合成阿片类药物致死人数(每3亿人1338.2[95%CI，662.5至2014.0])之间的正相关关系。尽管这项研究发现，现有的国家政策与减少处方阿片类药物的滥用有关，但它们可能会产生意想不到的后果，激励那些有阿片类药物使用障碍的人进入非法药物市场，潜在地增加过量死亡。这一发现表明，没有简单的政策解决方案来扭转阿片类药物依赖和死亡率在美国的流行。
This cross-sectional study assesses state drug policies implemented between 2007 and 2018 to ascertain whether they are associated with variations in opioid misuse, opioid use disorder, and drug overdose mortality. Are US state drug policies associated with variation in opioid misuse, opioid use disorder, and drug overdose mortality? In this cross-sectional study of state-level drug overdose mortality data and claims data from 23 million commercially insured patients in the US between 2007 and 2018, state policies were associated with a reduction in known indicators of prescription opioid misuse as well as deaths from prescription opioid overdose and increases in diagnosis of opioid use disorder, overdose, and drug overdose mortality from illicit drugs. Although existing state-level drug policies have been associated with a decrease in the misuse of prescription opioids, these policies may have had the unintended consequence of motivating those with opioid use disorders to switch to alternative illicit substances, inducing higher overdose mortality. In response to the increase in opioid overdose deaths in the United States, many states recently have implemented supply-controlling and harm-reduction policy measures. To date, an updated policy evaluation that considers the full policy landscape has not been conducted. To evaluate 6 US state-level drug policies to ascertain whether they are associated with a reduction in indicators of prescription opioid abuse, the prevalence of opioid use disorder and overdose, the prescription of medication-assisted treatment (MAT), and drug overdose deaths. This cross-sectional study used drug overdose mortality data from 50 states obtained from the National Vital Statistics System and claims data from 23 million commercially insured patients in the US between 2007 and 2018. Difference-in-differences analysis using panel matching was conducted to evaluate the prevalence of indicators of prescription opioid abuse, opioid use disorder and overdose diagnosis, the prescription of MAT, and drug overdose deaths before and after implementation of 6 state-level policies targeting the opioid epidemic. A random-effects meta-analysis model was used to summarize associations over time for each policy and outcome pair. The data analysis was conducted July 12, 2020. State-level drug policy changes to address the increase of opioid-related overdose deaths included prescription drug monitoring program (PDMP) access, mandatory PDMPs, pain clinic laws, prescription limit laws, naloxone access laws, and Good Samaritan laws. The outcomes of interests were quarterly state-level mortality from drug overdoses, known indicators for prescription opioid abuse and doctor shopping, MAT, and prevalence of drug overdose and opioid use disorder. This cross-sectional study of drug overdose mortality data and insurance claims data from 23 million commercially insured patients (12 582 378 female patients [55.1%]; mean [SD] age, 45.9 [19.9] years) in the US between 2007 and 2018 found that mandatory PDMPs were associated with decreases in the proportion of patients taking opioids (−0.729%; 95% CI, −1.011% to −0.447%), with overlapping opioid claims (−0.027%; 95% CI, −0.038% to −0.017%), with daily morphine milligram equivalent greater than 90 (−0.095%; 95% CI, −0.150% to −0.041%), and who engaged in drug seeking (−0.002%; 95% CI, −0.003% to −0.001%). The proportion of patients receiving MAT increased after the enactment of mandatory PDMPs (0.015%; 95% CI, 0.002% to 0.028%), pain clinic laws (0.013%, 95% CI, 0.005%-0.021%), and prescription limit laws (0.034%, 95% CI, 0.020% to 0.049%). Mandatory PDMPs were associated with a decrease in the number of overdose deaths due to natural opioids (−518.5 [95% CI, −728.5 to −308.5] per 300 million people) and methadone (−122.7 [95% CI, −207.5 to −37.8] per 300 million people). Prescription drug monitoring program access policies showed similar results, although these policies were also associated with increases in overdose deaths due to synthetic opioids (380.3 [95% CI, 149.6-610.8] per 300 million people) and cocaine (103.7 [95% CI, 28.0-179.5] per 300 million people). Except for the negative association between prescription limit laws and synthetic opioid deaths (−723.9 [95% CI, −1419.7 to −28.1] per 300 million people), other policies were associated with increasing overdose deaths, especially those attributed to non–prescription opioids such as synthetic opioids and heroin. This includes a positive association between naloxone access laws and the number of deaths attributed to synthetic opioids (1338.2 [95% CI, 662.5 to 2014.0] per 300 million people). Although this study found that existing state policies were associated with reduced misuse of prescription opioids, they may have the unintended consequence of motivating those with opioid use disorders to access the illicit drug market, potentially increasing overdose mortality. This finding suggests that there is no easy policy solution to reverse the epidemic of opioid dependence and mortality in the US.
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影响因子：
5.3
作者：
Alpert, Abby;Powell, David;Pacula, Rosalie Liccardo
通讯作者：
Pacula, Rosalie Liccardo
影响因子：
4.2
作者：
Bobashev, Georgiy;Tebbe, Kira;Hoffer, Lee
通讯作者：
Hoffer, Lee
CDC规定慢性疼痛的阿片类药物的指南 - 美国，2016年。
DOI：
10.1001/jama.2016.1464
发表时间：
2016-04-19
期刊：
JAMA
影响因子：
--
作者：
Dowell D;Haegerich TM;Chou R
通讯作者：
Chou R
DOI：
10.1126/science.aau1184
发表时间：
2018-09-21
期刊：
Science (New York, N.Y.)
影响因子：
--
作者：
Jalal H;Buchanich JM;Roberts MS;Balmert LC;Zhang K;Burke DS
通讯作者：
Burke DS
影响因子：
3.7
作者：
Meinhofer, Angelica
通讯作者：
Meinhofer, Angelica