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

拟议的R 01项目题为“国家法律对减少阿片类药物转移的影响， 过渡到注射毒品使用和艾滋病毒/丙型肝炎病毒传播”是检查国家法律的影响， 减少向注射吸毒过渡和艾滋病毒/丙型肝炎病毒感染过程中的类阿片转移和滥用。这些 各州的法律在内容和实施方面各不相同，包括州处方药监测计划 （PDMP）、可能减少处方阿片类药物获取的医疗补助政策，例如事先授权或 药房锁定计划，药物辅助治疗的医疗补助报销，以及 疼痛诊所这项拟议中的研究将探讨三个不同州的法律的影响，康涅狄格州， 选择肯塔基州和威斯康星州代表PDMP的差异，医疗补助对阿片类药物的限制 处方和疼痛诊所监管。我们还将研究当地环境（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）对向 在三个地方注射非处方类阿片和/或海洛因注射，一个城市地区，一个较小的 大都市区或郊区，以及农村城镇和周边县，选择以反映费率较高的地区 阿片类药物处方和阿片类药物过量具体目标包括：1）确定国家法律， 为减少类阿片滥用和转移而制定的政策， 与过渡到阿片类药物或海洛因注射有关; 2）确定当地如何实施州法律， 政策可能有助于从非医疗处方阿片类药物使用过渡到注射处方 比较城市、郊区和农村地区影响风险的当地因素 注射做法，如清洁注射器的供应、吸毒网络的密度和可及性 药物治疗项目。拟议的研究将采用两个阶段（形成和假设检验） 比较三个州和当地地区的混合方法设计（每个州3个，n=9），以检查因素 影响处方类阿片法律和政策与向类阿片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. .