Local health impacts of Prescription Monitoring Program use

描述（由申请人提供）：本提案是对RFA-CE-12-007的回应，与研究目标#5有关：评估国家处方药监测计划的健康影响。在过去的十年里，意外的药物中毒——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，处方监测计划（pmp）等政策工具已成为全州战略的重要组成部分，以防止处方药转移，促进更安全的可滥用药物处方，并最终降低阿片类药物过量死亡率。如果按预期广泛使用并充分发挥其潜力，PMP的使用可能会改变过量死亡率。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，可能影响用户亚群和非医疗用户的人口动态，可能改变当地的可获得性，并可能影响街头价格。本提案的总体目标是评估处方者和药剂师使用PMP作为预防青少年和成人意外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PMP使用情况，这些州具有不同的PMP概况和过量负担以及结果的高覆盖率：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，为进一步评估研究州PMP使用特征创建分类：a)管理州PMP使用和获取的法律法规，b)处方医师、药剂师和执法部门使用的PMP数据；2)在控制人口因素的情况下，测试PMP的存在、本地覆盖（注册使用PMP的专业人员比例为3位数邮政编码）和本地使用（PMP查询量为3位数邮政编码）对当地需求标记（使用和非医疗使用、处方阿片类药物使用的预定义类型、街头价格）、供应（处方模式、吗啡等效剂量分配、处方阿片类药物来源）的影响；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）；3)评估各州PMPs （n=40）目前的处方阿片类药物过量预防教育和规划工作，并检查具体的州或社区提供机制，以进行未来有针对性的干预。利用2009年至2012年三个独特来源的3位数邮政编码级别的数据-州PMPs，一个新的在线街头药物定价指数，以及一个国家实时监测数据集，该数据集捕获了正在评估药物滥用治疗的成人的处方阿片类药物使用和非医疗使用-本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。该提案针对“健康人群2020”的伤害和暴力预防重点领域，并符合NCIPC的绩效目标，即开展有针对性的研究项目，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.