An Evaluation of State Laws Intended to Curb High-Risk Opioid Prescribing

对旨在遏制高风险阿片类药物处方的州法律的评估

• 批准号: 9421929
• 负责人: Emma Elizabeth McGinty
• 金额: $ 36.59万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-30 至 2021-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9421929
• 关键词: Administrator; Affect; Anticonvulsants; Awareness; Benzodiazepines; Cessation of life; Clinic; Clinical; Data; Databases; Diagnosis; Dose; Drug Monitoring; Drug Prescriptions; Drug usage; Effectiveness; Enrollment; Epidemic; Evaluation; Fibromyalgia; Guidelines; Headache; Health; Health Personnel; Health Professional; Healthcare; Individual; Injection of therapeutic agent; Interview; Knowledge; Law Enforcement; Laws; Learning; Licensing; Low Back Pain; Medical; Methods; Non-Steroidal Anti-Inflammatory Agents; Opioid; Outcome; Outpatients; Pain; Pain Clinics; Pain management; Patients; Pattern; Pharmacology; Physical therapy; Policies; Primary Health Care; Provider; Reporting; Research; Resources; Risk; Societies; Specialist; Steroids; Structure; design; high risk; interest; mortality; overdose death; pill; prescription opioid; prevent; programs; trend

An Evaluation of State Laws Intended to Curb High-Risk Opioid Prescribing Opioid overdose deaths continue to increase in the U.S., with over 30,000 deaths in 2015. This epidemic is driven in large part by the high volume of opioids prescribed by healthcare providers. States have begun to enact laws designed to curb certain high-risk opioid prescribing practices, such as high-dose prescribing and overlapping opioid and benzodiazepine prescriptions, which are associated with misuse and mortality. Most recently, state efforts have centered on four types of laws. First, mandatory prescription drug monitoring program (PDMP) enrollment laws. While they exist in 49 states, only 35% of controlled substance prescribers report enrolling with PDMPs, or databases of controlled substance prescriptions that healthcare providers can access to learn about patients’ past and current prescription drug use. To increase PDMP use, 20 states have enacted mandatory PDMP enrollment laws, which require prescribers to enroll in – and thereby gain access to – their state’s PDMP. Second, mandatory PDMP query laws, which require providers to check the PDMP prior to prescribing opioids, have been enacted in 20 states. Third, pill mill laws, which strictly regulate pain clinics to prevent rogue clinics from issuing opioid prescriptions without medical indication, have been enacted in 11 states. Fourth, opioid prescribing cap laws, which limit days’ supply and/or dose of prescribed opioids, have been enacted in seven states. The effects of these laws on high-risk opioid prescribing are largely unknown. Using qualitative interviews and Quintiles LifeLink LRx/Dx prescription and outpatient claims data we propose a mixed methods study of how these four types of laws independently affect high-risk opioid prescribing. We will focus on 18 “treatment states” that enacted one of the four types of laws of interest – but no other laws designed to curb high-risk opioid prescribing – over a four-year period. We propose to: 1) explore the implementation and enforcement of the four types of laws in each of the 18 treatment states; 2) study the independent effects of these four types of state laws on high-risk opioid prescribing patterns; and 3) study the independent effects of the four types of laws on substitution of non-opioid pain treatments among individuals diagnosed with non-cancer chronic pain. For Aims 2 and 3 we will conduct synthetic control analyses comparing pre/post law trends in opioid prescribing in each treatment state to trends in a weighted combination of comparison states. A key strength of the proposed study is our ability to disentangle the causal effects of each of the four types of laws of interest on high-risk opioid prescribing. The mixed methods approach is another significant contribution: the results of our Aim 1 interviews will directly inform the design and interpretation of Aims 2 and 3. In the face of continuing increases in opioid overdose deaths and limited resources, state lawmakers need research evidence to inform decisions about policy enactment and implementation. The proposed study will fill critical gaps in knowledge regarding the effectiveness and implementation of state laws designed to curb high-risk opioid prescribing.

旨在遏制高风险阿片类药物使用的州法律评估 在美国，阿片类药物过量死亡人数继续增加，2015年死亡人数超过3万人。这场流行病是 这在很大程度上是由医疗保健提供者开出的大量阿片类药物推动的。各州已经开始 颁布旨在遏制某些高风险阿片类药物处方做法的法律，如高剂量处方和 阿片类药物和苯二氮卓类药物处方重叠，与滥用和死亡有关。多数 最近，国家的努力集中在四类法律上。第一，强制性处方药监管 计划(PDMP)招生法律。虽然它们存在于49个州，但只有35%的受控物质处方者 注册PDMP的报告，或医疗保健提供者可以使用的受控物质处方数据库 了解患者过去和目前的处方药使用情况。为了增加PDMP的使用，20个州有 制定了强制性的PDMP投保法，要求处方者注册-从而获得 -他们所在的州的PDMP。第二，强制性的PDMP查询法，要求提供商事先检查PDMP 到处方阿片类药物，已在20个州颁布。第三，药厂法律，它严格监管疼痛诊所 防止流氓诊所在没有医学指征的情况下开具阿片类药物处方，已于11年颁布 各州。第四，阿片类药物处方上限法，限制处方阿片类药物的天数供应和/或剂量，有 已在七个州颁布。这些法律对高风险阿片类药物处方的影响在很大程度上是未知的。 使用定性访谈和昆泰LifeLink LRx/Dx处方和门诊索赔 我们提出了一种混合方法研究这四种类型的法律如何独立地影响高风险 阿片类药物处方。我们将重点关注制定了四种法律之一的18个“治疗州” 利息--但没有其他旨在限制高风险阿片类药物处方的法律--在四年内。我们建议 目的：1)探索四类法律在18个治疗州中的实施和执行情况； 2)研究这四类州法律对高风险阿片类药物处方模式的独立影响；以及 3)研究四类法律对非阿片类疼痛治疗替代的独立影响 被诊断为非癌症慢性疼痛的个人。对于目标2和目标3，我们将进行综合控制 分析比较每个治疗州阿片类药物处方法律前后的趋势与加权的趋势 比较状态的组合。这项拟议研究的一个关键优势是我们有能力理清因果关系 四种利益法则对高风险阿片类药物处方的影响。混合方法 方法是另一个重要的贡献：我们目标1的采访结果将直接为设计提供信息 以及对目标2和目标3的解释。面对阿片类药物过量死亡和有限死亡的持续增加 资源，州立法者需要研究证据来为政策制定和决策提供信息 实施。拟议的研究将填补有关有效性和 执行旨在遏制高风险阿片类药物处方的州法律。