Local health impacts of Prescription Monitoring Program use

描述（由申请方提供）：本提案响应RFA-CE-12-007，与研究目标#5有关：评估州处方药监测项目的健康影响。在过去的十年里，无意的药物中毒-过量-急剧增加。由于这种增加在很大程度上与处方阿片类药物滥用的增加有关，处方监测计划（PMP）等政策工具已成为全州预防处方药转移战略的重要组成部分，促进滥用药物的更安全处方，并最终降低阿片类药物过量死亡率。PMP的使用可能会改变过量死亡率，如果广泛使用，按预期，并充分发挥其潜力。然而，目前尚不清楚PMP的使用如何影响其他非医疗处方阿片类药物的使用行为，可能影响使用者和非医疗使用者亚群的人口动态，可能改变当地的可用性，并可能影响街头价格。本提案的总体目标是评价处方医生和药剂师使用PMP作为预防青少年和成人人群意外处方药过量的一种手段对健康的影响。分析将侧重于7个研究州的地方层面的PMP使用情况，这些州具有不同的PMP特征和用药过量负担以及结局的高覆盖率：新墨西哥州、俄克拉荷马州、密歇根州、北卡罗来纳州、马里兰州、密苏里州和田纳西州。具体目标是：1）通过严格审查以下内容，创建分类法以进一步评价研究州的PMP使用特征：a）管理州PMP使用和获取的法律法规，以及B）关于处方者、药剂师和执法使用的PMP数据; 2）测试PMP存在的影响，本地覆盖（按3位邮政编码登记使用PMP的专业人员比例）和当地使用情况（PMP查询量，3位邮政编码），控制人口因素，根据当地需求标记（使用和非医疗使用、处方类阿片使用的预定义类型、街头价格）、供应（处方模式，分配的吗啡等效剂量，处方阿片类药物的来源），以及非医疗处方阿片类药物使用者的危害（给药途径、开始使用海洛因、非致命性过量）;和3）评估州PMP（n=40）目前的处方阿片类药物过量预防教育和规划工作，并检查未来有针对性的干预措施的具体州或社区交付机制。利用2009年至2012年三位数邮政编码级别的数据，这些数据来自三个独特的来源--州PMP、一个新的在线街头药品定价指数和一个全国性的实时数据，监测数据集，捕捉处方阿片类药物使用和非医疗使用的成年人正在评估药物滥用治疗-这项研究提出的核心分析将及时回答具有国家公共卫生重要性的研究问题。该提案涉及预防伤害和暴力的“2020年健康人”重点领域，符合NCIPC的绩效目标，即开展有针对性的研究方案，以预防伤害和暴力，并减少其后果。

DESCRIPTION (provided by applicant): This proposal is responsive to RFA-CE-12-007, pertaining to research objective #5: to assess the health impact of a state Prescription Drug Monitoring Program. Unintentional drug poisonings-overdoses-have drastically increased over the past decade. Because much of this increase has been associated with increasing abuse of prescription opioid medications, policy tools like Prescription Monitoring Programs (PMPs) have become an important part of statewide strategies to prevent prescription drug diversion, promote safer prescribing of abuseable medications, and ultimately reduce opioid overdose mortality. PMP use may alter overdose mortality, if used widely, as intended, and to their full potential. However, it is unknown how PMP use may impact other nonmedical prescription opioid use behavior, may influence population dynamics of subpopulations of users and nonmedical users, may alter local availability, and may affect street price. The overarching goal of this proposal is to evaluate the health impact of PMP utilization by prescribers and pharmacists as a means of preventing unintentional prescription drug overdoses in the adolescent and adult population. Analyses will focus on PMP utilization at the local level in 7 study states with varying PMP profiles and overdose burden and high coverage rates for outcomes: New Mexico, Oklahoma, Michigan, North Carolina, Maryland, Missouri, and Tennessee. Specific aims are to: 1) Create taxonomies for further evaluation of PMP use characteristics in study states by critically reviewing: a) laws and regulations governing the use and access of the state PMPs, and b) PMP data on prescriber, pharmacist, and law enforcement use; 2) Test the effects of PMP presence, local coverage (proportion of professionals registered for PMP use at 3-digit ZIP code) and local use (PMP query volume at 3-digit ZIP code), controlling for population factors, on local markers of demand (use and nonmedical use, predefined typologies of prescription opioid use, street price), supply (prescribing patterns, morphine-equivalent dose dispensed, source of prescription opioid), and harm among nonmedical prescription opioid users (route of administration, initiation of heroin use, nonfatal overdose); and 3) Assess state PMPs' (n=40) current prescription opioid overdose prevention education and programming efforts and examine specific state or community delivery mechanisms for future targeted interventions. Drawing upon data available from 2009 to 2012 at the 3-digit ZIP code level from three unique sources - state PMPs, a novel online street drug pricing index, and a national, real-time, surveillance dataset that captures prescription opioid use and nonmedical use from adults being assessed for substance abuse treatment-the core analyses proposed in this study will answer timely research questions of national public health importance. This proposal addresses the "Healthy People 2020" focus area(s) of Injury and Violence Prevention and is in line with the NCIPC's performance goal to conduct a targeted program of research to prevent injuries and violence, and reduce their consequences.