Effects of State Laws to Reduce Opioid Diversion on Transitions to Injection Drug Use and HIV/HCV Transmission

拟议的R01项目的目的是“国家法律对减少阿片类药物转用的影响” 过渡到注射吸毒和艾滋病毒/丙型肝炎传播“是为了审查国家法律设计的影响 减少阿片类药物在向注射吸毒和艾滋病毒/丙型肝炎病毒感染过渡过程中的转用和滥用。这些 法律的内容和实施因州而异，并包括州处方药监测计划 (PDMPS)，可能会减少获得处方阿片类药物的医疗补助政策，如事先授权或 药房锁定计划，药物辅助治疗的医疗补助报销，以及州法规 疼痛诊所。这项拟议的研究将探索三个不同州的法律影响，康涅狄格州， 肯塔基州和威斯康星州被选为代表PDMP的差异，医疗补助对阿片类药物的限制 处方，以及疼痛诊所的规定。我们还将审查当地环境(药物使用)的影响 网络、注射器供应、减少危害服务、海洛因的相对价格和质量)向 在三个地方注射非处方阿片类药物和/或注射海洛因，一个城市地区，一个较小的地区 大都市区或郊区，以及乡村城镇和周围的县，选择来反映利率较高的地区 阿片类药物处方和阿片类药物过量。具体目标包括：1)确定州法律和 已经制定的减少阿片类药物滥用和转移的政策，以确定或驳斥其 与向阿片类药物或海洛因注射过渡有关；2)查明地方如何执行州法律和 政策可能有助于从非医疗处方阿片类药物使用向注射处方过渡 阿片类药物或注射海洛因；3)比较城市、郊区和农村地区影响风险的当地因素 注射做法，如清洁注射器的可用性、吸毒网络的密度和可获得性 戒毒治疗项目。拟议的研究将使用两个阶段(形成阶段和假设检验)。 混合方法设计比较三个州和地区(每个州3个，n=9)以检查因素 影响处方阿片类药物法律和政策与向阿片类药物或海洛因过渡之间的关系 注射。 。

The purpose of the proposed R01 project entitled “Effects of State Laws to Reduce Opioid Diversion on Transitions to Injection Drug Use and HIV/HCV Transmission” is to examine the effects of state laws designed to reduce opioid diversion and misuse on the transition to injection drug use and HIV/HCV infection. These laws vary in content and implementation by state and include state prescription drug monitoring programs (PDMPs), Medicaid policies that may decrease access to prescription opioids such as prior authorization or pharmacy lock-in programs, Medicaid reimbursement of Medication Assisted therapy, and state regulations of pain clinics. The proposed research will explore the influence of laws in three different states, Connecticut, Kentucky and Wisconsin, selected to represent differences in PDMPs, Medicaid restrictions on opioid prescription, and pain clinic regulation. We will also examine the effects of the local context (drug use networks, syringe availability, harm reduction services, relative price and quality of heroin) on the transition to injecting non-prescription opioids and /or heroin injection in three local areas, an urban area, a smaller metropolitan area or suburb, and a rural town and surrounding county, chosen to reflect areas with higher rates of opioid prescription and opioid overdoses. Specific aims include the following: 1) Identify state laws and policies that have been established to decrease opioid misuse and diversion to establish or refute their association with transition to opioid or heroin injection; 2) Identify how local implementation of state laws and policies may contribute to the transition from nonmedical prescription opioid use to injecting prescription opioids or injecting heroin; 3) Compare local factors in urban, suburban and rural areas that affect the riskiness of injection practices such as the availability of clean syringes, density of drug using networks and accessibility of drug treatment programs. The proposed research will use a two-phase (formative and hypothesis testing) mixed methods design comparing the three states and local areas (3 per state, n=9) to examine factors affecting the relationship between prescription opioid laws and policies and the transition to opioid or heroin injection. .