Local health impacts of Prescription Monitoring Program use

描述(由申请人提供)：本提案响应RFA-CE-12-007，与研究目标#5有关：评估州处方药监测计划对健康的影响。在过去的十年里，非故意的药物中毒--吸毒过量--急剧增加。由于这一增长在很大程度上与处方阿片类药物滥用的增加有关，因此像处方监测计划(PMPs)这样的政策工具已经成为全州战略的重要组成部分，以防止处方药转移，促进可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的死亡率，如果广泛使用的话，如预期的那样，并发挥其全部潜力。然而，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，可能改变当地的可获得性，以及可能影响市场价格，目前尚不清楚。这项建议的总体目标是评估处方医生和药剂师使用PMP作为预防青少年和成人人口无意处方药过量的一种手段对健康的影响。分析将集中在7个研究州的地方一级的PMP利用率，这些州的PMP概况不同，结果的过量负担和高覆盖率：新墨西哥州、俄克拉何马州、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：a)管理国家PMP的使用和访问的法律和法规，以及b)关于处方者、药剂师和执法人员使用的PMP数据，为进一步评估研究州的PMP使用特征创建分类法；2)测试PMP的存在、当地覆盖率(以3位邮政编码登记的专业人员比例)和当地使用(以3位邮政编码登记的PMP查询量)、对人口因素的控制、对当地需求标记(使用和非医疗使用、处方阿片使用的预定义类型、街道价格)、供应(处方模式、分配的吗啡当量剂量、处方阿片的来源)以及非医用处方阿片使用者的危害(给药途径、开始使用海洛因、非致命过量)的影响；3)评估州PMP(n=40)目前的处方阿片类药物过量预防教育和方案编制工作，并检查具体的州或社区提供机制，以进行未来有针对性的干预。根据2009年至2012年3位邮政编码级别的数据，来自三个独特的来源-州PMP，一个新的在线街头药物定价指数，以及一个全国性的实时监测数据集，捕获正在接受药物滥用治疗评估的成年人的处方阿片类药物使用和非医疗使用情况-这项研究中提出的核心分析将及时回答国家公共卫生重要性的研究问题。这一建议针对的是“健康人2020”重点领域(S)的伤害和暴力预防，并与国家预防和暴力委员会开展有针对性的研究计划以预防伤害和暴力并减少其后果的业绩目标保持一致。

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.