Effectiveness of Mandatory Prescription Drug Monitoring

强制处方药监测的有效性

• 批准号: 8223182
• 负责人: GUOHUA LI
• 金额: $ 19万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-04-01 至 2014-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8223182
• 关键词: Accident and Emergency department; Accidental Injury; Accounting; Adoption; Alprazolam; Automation; Benzodiazepines; Cause of Death; Centers for Disease Control and Prevention (U.S.); Cessation of life; Characteristics; Clonazepam; Code; Consumption; Data; Data Files; Demographic Factors; Diazepam; Drug Formulations; Drug Monitoring; Drug Prescriptions; Drug abuse; Effectiveness; Elements; Epidemic; Epidemiologic Studies; Federal Government; Grant; Hydrocodone; Individual; Information Systems; International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10); Intervention; Law Enforcement; Light; Lorazepam; Measures; Modeling; Morbidity - disease rate; Non-Prescription Drugs; Opioid Analgesics; Outcome Measure; Overdose; Oxycodone; Patient Education; Pattern; Pharmaceutical Preparations; Pharmacologic Substance; Physicians; Poisoning; Policies; Prevention program; Reporting; Research; Research Design; Research Personnel; Risk; Sales; Schedule; Series; Socioeconomic Factors; System; Testing; Time; United States; United States National Center for Health Statistics; Visit; attributable mortality; design; disorder prevention; effective intervention; intervention program; mortality; multilevel analysis; nonmedical use; prescription drug abuse; prevent; programs; public health relevance; response; socioeconomics; substance abuse prevention

DESCRIPTION (provided by applicant): The broad, long term objective of the proposed project is to develop effective intervention programs for controlling the epidemic of unintentional prescription drug overdoses in the United States. The specific aims are: (1) to assess the effectiveness of state Prescription Drug Monitoring Programs (PDMPs) in reducing the sales and consumption of prescription drugs; (2) to assess the effectiveness of state PDMPs in reducing unintentional fatalities from prescription drug overdoses; and (3) to examine the association between state PDMPs and the likelihood that a poisoning death is due to unintentional prescription drug overdose. With a marked increase in the sales and consumption of Schedule II pharmaceuticals, the annual numbers of emergency department visits and unintentional deaths related to prescription drug overdoses in the United States have more than doubled since 1999. Claiming over 22,000 lives each year, prescription drug overdose has become the second leading cause of unintentional injury mortality. Previous studies have revealed that the majority of unintentional overdose morbidity and mortality are attributable to nonmedical use of opioid analgesics and benzodiazepines obtained from diversion and 'doctor shopping.' Prevention programs concentrated on physician and patient education have been inadequate to control the ongoing epidemic of prescription drug overdoses. The U.S. federal government in 2002 started the Harold Rogers grant program to support the creation and improvement of state PDMPs. As of January 2010, 34 states have established operational PDMPs, and the Centers for Disease Control and Prevention has recently called for the nationwide adoption of PDMPs. Although PDMPs represent a major policy intervention on the diversion and abuse of prescription drugs, their effectiveness in decreasing illegal transactions and detrimental consequences of prescription drug abuse has not been rigorously evaluated. The proposed project aims to test three hypotheses: (1) PDMP implementation is associated with significantly decreased sales and consumption of prescription drugs; (2) PDMP implementation is associated with significantly decreased mortality from unintentional prescription drug overdoses; and (3) PDMP implementation is associated with a significantly decreased likelihood that a poisoning death is due to unintentional prescription drug overdose. These hypotheses will be tested using quarterly data for the years 1999- 2008 from the Automation of Reports and Consolidated Orders System and the multi-cause-of-death data files, and the linear mixed effects model and multilevel individual response model with adjustment for demographic and socioeconomic factors and serial autocorrelation. Findings from the proposed research can provide much-needed empirical evidence for policy reform and improvement to control the epidemic of prescription drug overdoses. PUBLIC HEALTH RELEVANCE: Morbidity and mortality from unintentional drug overdose in the United States have more than doubled since 1999, mainly due to nonmedical use of opioid analgesics and benzodiazepines obtained through drug diversion and 'doctor shopping.' Physician and patient education programs have been inadequate to control the epidemic of prescription drug overdoses. The proposed project aims to evaluate the effectiveness of state Prescription Drug Monitoring Programs in reducing the sales and consumption of controlled substances and deaths from unintentional overdose of prescription drugs, and to provide scientific evidence for policy interventions on the ongoing epidemic.

描述（由申请人提供）：拟议项目的广泛，长期目标是制定有效的干预计划，以控制美国无意处方药过量的流行。具体目标是：（1）评估州处方药监测计划（PDMP）在减少处方药销售和消费方面的有效性;（2）评估州处方药监测计划在减少处方药过量意外死亡方面的有效性;（3）检查州处方药监测计划与意外处方药过量导致中毒死亡的可能性之间的关联。随着附表二药物的销售和消费显著增加，美国每年因处方药过量而到急诊室就诊和意外死亡的人数自1999年以来增加了一倍多。处方药过量每年夺去22，000多人的生命，已成为意外伤害死亡的第二大原因。先前的研究表明，大多数无意过量发病率和死亡率可归因于非医疗使用从转移和“医生购物”中获得的阿片类镇痛药和苯二氮卓类药物。“集中在医生和患者教育上的预防计划不足以控制处方药过量的持续流行。美国联邦政府于2002年启动了哈罗德·罗杰斯赠款计划，以支持州PDMP的创建和改进。截至2010年1月，34个州已经建立了可操作的PDMP，疾病控制和预防中心最近呼吁在全国范围内采用PDMP。虽然PDMP代表了对处方药转移和滥用的主要政策干预，但其在减少非法交易和处方药滥用的有害后果方面的有效性尚未得到严格评估。拟议的项目旨在检验三个假设：（1）实施PADS 2与处方药的销售和消费显著减少有关;（2）实施PADS 2与非故意处方药过量死亡率显著降低有关;（3）实施PADS 2与非故意处方药过量导致中毒死亡的可能性显著降低有关。这些假设将使用1999- 2008年的季度数据进行检验，这些数据来自报告和综合订单自动化系统和多死因数据文件，以及调整人口和社会经济因素和序列自相关的线性混合效应模型和多层次个体响应模型。研究结果可为控制处方药过量流行的政策改革和改进提供急需的经验证据。 公共卫生相关性：自1999年以来，美国非故意药物过量的发病率和死亡率增加了一倍多，主要是由于通过药物转移和“医生购物”获得的阿片类镇痛剂和苯二氮卓类药物的非医疗使用。医生和病人的教育计划不足以控制处方药过量的流行。拟议项目旨在评估州处方药监测方案在减少受管制物质的销售和消费以及因无意过量服用处方药而导致的死亡方面的有效性，并为针对正在发生的流行病的政策干预提供科学证据。