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

旨在遏制高风险阿片类药物处方的州法律的评估 在美国，阿片类药物过量死亡人数继续增加，2015年有超过3万人死亡这次疫情是 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驱动的。国家已开始 制定旨在遏制某些高风险阿片类药物处方做法的法律，例如高剂量处方， 阿片类药物和苯二氮卓类药物处方重叠，这与滥用和死亡率有关。最 最近，国家的努力集中在四类法律上。一是强制性处方药监测 计划（PAPs）招生法。虽然它们存在于49个州，但只有35%的受控物质处方者 报告注册PDMP，或医疗保健提供者可以 了解患者过去和当前的处方药使用情况。为了增加Pesticide的使用，20个州已经 颁布了强制性的PSTs登记法，要求处方者登记-从而获得 - 他们的国家的总统。第二，强制性的Pingdom查询法，要求提供商检查Pingdom之前 开阿片类药物处方的法律已经在20个州颁布。第三，药丸厂法律，严格规范疼痛诊所， 防止流氓诊所在没有医学指征的情况下开出阿片类药物处方， states.第四，阿片类药物处方上限法限制了处方阿片类药物的供应和/或剂量， 已在7个州实施。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处方和门诊报销 数据，我们提出了一个混合方法研究如何这四种类型的法律独立影响高风险 阿片类药物处方我们将重点关注18个“治疗状态”，这些状态颁布了四种类型的法律之一， 利益-但没有其他法律旨在遏制高风险阿片类药物处方-超过四年的时间。我们提出 （1）探讨这四类法律在18个处理国中的每一个国家的实施和执行情况; 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; 3)研究四种类型的法律对非阿片类药物疼痛治疗替代的独立影响， 被诊断患有非癌症慢性疼痛的人。对于目标2和3，我们将进行综合控制 分析比较了每种治疗状态下阿片类药物处方的法律前/法律后趋势与加权 比较状态的组合。这项研究的一个关键优势是我们能够理清因果关系， 四种类型的法律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：我们的目标1访谈的结果将直接告知设计 以及对目标2和3的解释。面对阿片类药物过量死亡和有限的 资源，州立法者需要研究证据来告知有关政策制定的决定， 实施.拟议的研究将填补关于有效性和 实施旨在遏制高风险阿片类药物处方的州法律。

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.