Benzodiazepine restrictions and the prevention of overdoses and other harms

项目总结/摘要 苯二氮卓类药物是一种令人上瘾但在美国常见的处方药物，其使用是独立的 与严重的健康后果有关，包括福尔斯和骨折。苯二氮卓类药物也经常涉及 阿片类药物相关的过量，强调其在美国阿片类药物流行病中的相关性。苯二 过去已经实施了覆盖限制和其他监管行动，以减少 苯二氮卓类药物的使用和相关危害，尽管这些行动的预期和非预期影响仍然存在 不清楚其中一个具有国家影响的限制是， 2006年实施医疗保险D部分期间的医疗保险登记者。与此同时，田纳西州 Medicaid（TennCare）计划对所有登记者的苯二氮卓类药物覆盖范围进行了限制。TennCare 是全国唯一一个这样做的州医疗补助计划。因此，TennCare注册者（包括双 killbles）在2006年至2013年期间没有从医疗补助或医疗保险中获得苯二氮卓类药物， 当时限制被部分取消，然后在2014年完全取消。这种间歇性的限制 随后重新引入苯二氮卓类药物的覆盖范围是TennCare登记者所独有的， 设置一个自然的实验，以确定苯二氮卓类药物限制对苯二氮卓类药物的影响- 相关危害和其他精神药物的使用。建议的工作将使用追溯 纵向TennCare数据链接到医疗保险D部分，重要记录和州住院数据，以检查 三个具体目标：目标1：检验2006年苯二氮卓类药物限制导致较低发病率的假设 有苯二氮卓类药物适应症的TennCare患者中的福尔斯、骨折和阿片类药物相关过量 与无苯二氮卓类适应症的患者相比。目的2：检验以下假设： 2006年和2014年实施并随后取消了苯二氮卓类药物限制， 其他类似适应症精神药物的处方填充率的变化， 有苯二氮卓类药物使用适应症的TennCare患者。目的3：检验去除 2014年对苯二氮卓类药物的限制导致了更高的福尔斯、骨折和阿片类药物相关过量的发生率， 有苯二氮卓类药物使用适应症的患者与无苯二氮卓类药物使用适应症的患者相比 使用.告知拟议的工作和发展一个独立的研究计划，重点是药物 安全研究，候选人已确定具有相关专业知识的导师，以监督额外的培训 机会在（1）应用先进的差异中的差异设计评估状态 政策变化，（2）使用苯二氮卓类药物和其他药物的患者的临床需求和护理障碍 精神药物，以及（3）索赔数据与其他临床和管理数据的大规模关联 源这项研究的结果将为未来减少苯二氮卓类和阿片类药物的策略提供信息。 相关危害，包括苯二氮卓类和阿片类药物相关的过量和死亡。

PROJECT SUMMARY/ABSTRACT The use of benzodiazepines, an addictive yet commonly prescribed class of drugs in the US, is independently linked to serious health outcomes, including falls and fractures. Benzodiazepines are also frequently involved in opioid-related overdoses, underscoring their relevance in the ongoing US opioid epidemic. Benzodiazepine coverage restrictions and other regulatory actions have been implemented in the past to reduce benzodiazepine use and related harms, though the intended and unintended impact of these actions remains unclear. One such restriction with national implications was the exclusion of benzodiazepines coverage for Medicare enrollees during the implementation of Medicare Part D in 2006. At the same time, the Tennessee Medicaid (TennCare) program instituted a restriction on benzodiazepine coverage for all enrollees. TennCare was the only State Medicaid program in the country to do so. Thus, TennCare enrollees (including dual- eligibles) did not have benzodiazepine coverage from either Medicaid or Medicare from 2006 through 2013, when the restriction was partially removed, and then completely removed in 2014. This intermittent restriction and subsequent reintroduction of benzodiazepine coverage is unique to TennCare enrollees and provides the setting for a natural experiment to determine the impact of benzodiazepine restrictions on benzodiazepine- related harms and the use of other psychotropic medications. The proposed work will use retrospective longitudinal TennCare data linked to Medicare Part D, Vital Records, and State hospitalization data to examine three specific aims: Aim 1: To test the hypothesis that benzodiazepine restrictions in 2006 led to a lower rate of falls, fractures and opioid-related overdoses among TennCare patients with indications for benzodiazepines use compared to patients without indications for benzodiazepines. Aim 2: To test the hypothesis that the implementation and subsequent removal of benzodiazepine restrictions in 2006 and 2014 led to compensatory changes in the rates of filled prescriptions for other similarly indicated psychotropic medications among TennCare patients with indications for benzodiazepine use. Aim 3: To test the hypothesis that the removal of benzodiazepine restrictions in 2014 led to a higher rate of falls, fractures and opioid-related overdoses among patients with indications for benzodiazepine use compared to patients without indications for benzodiazepine use. To inform the proposed work and the development of an independent research program focused on drug safety research, the candidate has identified mentors with relevant expertise to oversee additional training opportunities in (1) the application of advanced difference-in-difference designs for the evaluation of state policy changes, (2) the clinical needs and barriers to care among patients that use benzodiazepines and other psychotropic drugs, and (3) the large-scale linkage of claims data with other clinical and administrative data sources. Findings from this study will inform future strategies to reduce benzodiazepine- and opioid- related harms, including benzodiazepine and opioid-related overdoses and death.