Unintentional Prescription Opioid Poisoning Deaths in Connecticut and Rhode Islan

描述(由申请人提供)： 拟议的项目响应了本FOA的研究目标#4和#5：评估可能影响处方药过量上升的政策或环境的最新变化(#4)，并利用二次数据分析为关于处方药过量预防的政策辩论提供信息(#5)。目的：本提案的首要目标是探索康涅狄格州(CT)和罗德岛州(RI)的两个全州处方监测计划(PMP)在减少成人处方阿片类药物意外中毒死亡方面的效用和有效性。重要性：除了执法应用外，PMP作为一种结构性公共卫生干预形式可能在减少过量死亡方面具有更广泛的效用，这种干预形式可能会影响药物的转移和获得，并作为独特公共卫生数据的生成器。这项研究的结果将有助于了解PMP目前的使用情况及其在处方阿片类药物过量监测和预防方面的潜力。具体目的：(目的1)通过在CT和RI成人中进行配对病例对照研究，确定PMP数据是否可以发现阿片类药物转移和异常阿片类药物使用与处方阿片类药物意外过量死亡风险之间的关联。我们将首先：(目标1a)使用PMP汇编的处方“填充”数据完善异常使用阿片类药物(即购买医生)的定义；(目标1b)对法医案件进行法医案件调查，以确定病例和对照；(目标2)：评估国家处方管理计划目前是否被用于检测过量风险，方法是：(目标2a)对处方医生和配药员进行关于处方管理计划使用情况的在线调查，(目标2b)审查处方阿片类药物过量死者的居住地地理分布、使用情况与社区处方阿片类药物配发量之间的关系；和(目标3)进行快速评估和反应(RAR)，以核实PMP和其他数据来源在两个社区(一个在RI，一个在CT)产生反映高处方阿片类药物过量风险的数据，并确定PMP和其他反应可用于防止那里致命的处方阿片过量的方法。研究设计：a)病例对照分析，b)横断面调查，c)RAR人种学调查。地点/参与者：a)2009年在CT和RI中发生的所有成人中与药物有关的死亡，来自州法医办公室数据库，也出现在PMP数据库中。病例将是那些意外中毒死亡，涉及处方阿片类药物作为唯一的阿片类药物。控制将是任何意图的与药物有关的死亡，与年龄组、居住地和死亡月份的病例相匹配。B)注册使用CT PMP的CT临床医生(n=1400)和药剂师(n=210)、上传处方数据的RI药店(n=200)和RI许可提供者(n=7955)将接受调查。C)两个城镇，一个在RI，一个在CT，处方药过量致死率很高。干预：无。观察指标：1)致命的处方阿片类药物过量事件；2)处方阿片类药物的转移；3)医生/药房购物；4)提供者使用PMP(自我报告，行政记录)；5)社区验证：处方阿片类药物过量问题的定义和PMP的潜在预防益处。 公共卫生相关性： 处方监测计划(PMP)可能对患者、处方医生、药剂师、决策者和社会具有更广泛的效用，既是一种可以影响药物转移和获得的结构性公共卫生干预形式，也是独特的公共卫生数据的来源。这项研究将通过将康涅狄格州和罗德岛州的法医、PMP和其他州机构的数据联系起来，并通过在两个被发现经历高处方过量死亡率的新英格兰社区进行社区实地调查，帮助理解PMP数据在减少意外致命的处方阿片类药物过量方面的潜在公共卫生应用。

DESCRIPTION (provided by applicant): The proposed project is responsive to research objectives #4 and #5 of this FOA: to evaluate recent changes in policies or environments that could influence the rising rate of prescription drug overdoses (#4), and to inform policy debate on prescription drug overdose prevention using secondary data analyses (#5). Objectives: The overarching goal of this proposal is to explore the utility and effectiveness of two statewide prescription monitoring programs (PMPs), in Connecticut (CT) and Rhode Island (RI), in reducing prescription opioid-involved accidental intoxication deaths among adults. Importance: Beyond their law enforcement application, PMPs may have broader utility in reducing overdose deaths as a form of structural public health intervention that can influence diversion and access to medications and as a generator of unique public health data. Results from this research will help understand how PMPs are currently being used and their potential for prescription opioid overdose surveillance and prevention. Specific Aims: (Aim 1) To determine if PMP data can detect an association between opioid diversion and aberrant opioid utilization and risk of prescription opioid accidental overdose death by conducting a matched case-control study among adults in CT and RI. We will first: (Aim 1a) refine the definition of aberrant opioid utilization (i.e., doctor shopping) using prescription "fill" data compiled by PMPs; and (Aim 1b) perform a forensic case investigation of medical examiner cases to identify cases and controls; (Aim 2): To assess whether state PMPs are, at present, being used in a way to detect overdose risk by: (Aim 2a) conducting an online survey of prescribers and dispensers on use of the PMP and (Aim 2b) examining associations between the geographic distribution of residence of decedents of prescription opioid overdose, use of the PMP, and the amount of prescribed opioid dispensed in the community; and (Aim 3) To conduct a rapid assessment and response (RAR) to verify that PMPs and other data sources generate data reflective of high prescription opioid overdose risk in two communities, one in RI and one in CT, and to determine ways that PMPs and other responses can be used to prevent fatal prescription opioid overdose there. Study Design: a) Case-control analysis, b) cross-sectional survey, and c) RAR ethnographic investigation. Setting/Participants: a) all deaths involving drugs among adults occurring in CT and RI during 2009 from the state medical examiner's office databases who also appear in the PMP database. Cases will be those accidental intoxication deaths involving a prescription opioid as the only opioid. Controls will be drug-involved deaths of any intent, matched to the case on age group, county of residence, and month of death. b) CT clinicians (n=1400) and pharmacists (n=210) registered to use the CT PMP, RI pharmacies (n=200) who upload prescription data, and RI licensed providers (n=7955) will be surveyed. c) two cities/towns, one in RI and one in CT, experiencing high rates of fatal prescription opioid-involved overdose. Intervention: None. Outcome measures: 1) fatal prescription opioid overdose events; 2) diversion of prescription opioids; 3) doctor/pharmacy shopping; 4) use of PMP by providers (self-reported, administrative records); 5) community-verified: prescription opioid overdose problem definition and potential prevention benefit of PMP. PUBLIC HEALTH RELEVANCE: Prescription monitoring programs (PMPs) may have broader utility to patients, prescribers, pharmacists, decision makers and to society both as a form of structural public health intervention that can influence diversion and access to medications and as a source of unique public health data. This study will help understand the potential public health application of PMP data to reducing unintentional fatal prescription opioid overdose through linkage of medical examiner, PMP, and other state agency data in Connecticut and Rhode Island and by conducting community-based field investigations in two New England communities found to be experiencing high rates of prescription overdose death.