Evaluation of a community-based initiative to prevent opioid overdose

对预防阿片类药物过量的社区举措的评估

• 批准号: 8462416
• 负责人: CHRISTOPHER L RINGWALT
• 金额: $ 20万
• 依托单位: PACIFIC INSTITUTE FOR RES AND EVALUATION
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-30 至 2014-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8462416
• 关键词: Evaluation; community; based; initiative; prevent

DESCRIPTION (provided by applicant): Rates of mortality attributable to unintentional poisoning are rising rapidly as a consequence of both the medical and non-medical use of prescribed opioid analgesics. Project Lazarus, which was created to respond to North Carolina's epidemic of abuse of opioid analgesics, is a novel community-based drug overdose prevention program designed to reduce the supply of, demand for, diversion of and risks associated with opioid analgesics, while promoting the optimal treatment of chronic pain. A preliminary efficacy study has demonstrated dramatic effects on decreases in deaths attributable to opioid misuse and abuse without adversely affecting prescriptions for opioid analgesics. Now called the Project Lazarus/Chronic Pain Initiative (PL/CPI), Project Lazarus is collaborating with NC's Medicaid Authority to expand this initiative to all counties in the State. The goal of the intervention is to reduce the risks associated with opioid analgesics while maintaining appropriate access to these medications for control of chronic pain. We propose a two year effectiveness study to test whether this statewide community- based initiative: 1. increases providers' rates of registry and consultation with the State's prescription monitoring program, the Controlled Substances Reporting System (CSRS); 2. improves access to substance abuse treatment by increasing the number of individuals who receive medically-assisted treatment (MAT) for opioid dependence; 3. decreases monthly county-level drug-related emergency department (ED) visit rates attributable to opioid overdoses, using a unique statewide population-based ED surveillance system; and 4. is associated with a reduction in annual county-level age-adjusted opioid-related unintentional poisoning mortality rates. Substantial efficiencies in this natural quasi-experimental study will be achieved insofar as full support for the implementation of the PL/CPI is already available from NC's Medicaid Program and several foundations, thus limiting the resources we are requesting of the CDC to those that are required to conduct the evaluation itself. The highly innovative community-based opioid poisoning prevention strategies that constitute the PL/CPI are deserving of an evaluation and, if found to be effective, of replication across the country to respond to the nation' exploding epidemic of prescription drug overdose. PUBLIC HEALTH RELEVANCE: Deaths due to the abuse and misuse of opioid analgesics have nearly doubled in the U.S. in the last past 10 years, and the U.S. rates of ED visits related to narcotic analgesics rose by 155% between 2004 and 2009. There are now about 9000 daily cases of prescription opioid abuse, and their total costs to society as of 2009 were estimated at $56 billion, of which $25 billion were borne by the health care system. The proposed study would evaluate the first statewide implementation of a community and provider based opioid overdose prevention initiative in the nation.

说明(申请人提供)：由于医用和非医用处方阿片类镇痛剂的使用，可归因于非故意中毒的死亡率正在迅速上升。Lazarus项目是为应对北卡罗来纳州阿片类止痛药滥用的流行而创建的，是一项新型的社区药物过量预防计划，旨在减少阿片类止痛药的供应、需求、转移和相关风险，同时促进慢性疼痛的最佳治疗。一项初步疗效研究表明，在不对阿片类止痛药处方产生不利影响的情况下，可归因于阿片类药物滥用和滥用的死亡人数减少了显著效果。现在被称为Lazarus/慢性疼痛倡议(PL/CPI)的Project Lazarus正在与北卡罗来纳州的医疗补助机构合作，将这一倡议扩展到该州的所有县。干预的目标是降低与阿片类止痛药相关的风险，同时保持适当的获得这些药物的机会，以控制慢性疼痛。我们提议进行一项为期两年的有效性研究，以测试这一全州范围的社区倡议是否：1.提高提供者的登记率和与州处方监督计划的咨询率 控制物质报告系统(CSRS)；2.通过增加因阿片类药物依赖而接受医疗辅助治疗(MAT)的人数，改善药物滥用治疗的机会；3.利用独特的全州范围内与阿片类药物有关的急诊监测系统，减少每月因阿片类药物过量而导致的县级药物相关急诊科就诊率；4.与年度县级年龄调整后与阿片类药物相关的意外中毒死亡率的降低有关。只要北卡罗来纳州的医疗补助计划和几个基金会已经为PL/CPI的实施提供了充分的支持，这项自然的准实验研究将实现实质性的效率，从而将我们向CDC请求的资源限制为进行评估本身所需的资源。构成PL/CPI的高度创新的社区阿片类药物中毒预防策略值得评估，如果被发现有效，则应在全国推广，以应对全国爆炸性的处方药过量流行。 公共卫生相关性：在过去的10年里，美国因滥用和误用阿片类止痛药而死亡的人数几乎翻了一番，2004年至2009年间，美国因麻醉性止痛药而就诊的急诊率上升了155%。目前，每天约有9000例处方阿片类药物滥用，截至2009年，其给社会造成的总成本估计为560亿美元，其中250亿美元由医疗保健系统承担。拟议的研究将评估全国第一次在全州范围内实施基于社区和提供者的阿片类药物过量预防倡议。