Measuring the Presence of Opioid Markets in Local Communities and Their Impacts on Harm

项目摘要 处方阿片类药物一直是阿片类药物流行的主要驱动因素，但最近， 海洛因和芬太尼急剧增加。然而，这些趋势在全国范围内并不一致， 我们对联邦和州的政策的异质性影响知之甚少，这些政策试图遏制 吸毒过量率已实施了许多政策来应对阿片类药物滥用的上升，包括 处方药监测计划（PDMP），药丸厂法规，以及联邦鼓励滥用- 威慑制剂。最近的研究表明，这些干预措施可能会促进替代， 非医疗处方阿片类药物的使用滥用海洛因和芬太尼，部分解开这些好处 施政纲要而这种国家一级的证据掩盖了大量的地方异质性。在这个项目中，我们将 探索这种异质性，以了解哪些类型的社区将受到某些政策的影响最大 并且当个体替代更有害的药物时，将经历这样的意想不到的后果。这 证据对于预测联邦和州政策的地方后果以及提供 帮助减轻此类意外伤害的信息。 我们的分析集中在两个核心因素，可能决定当地的影响，联邦和州的政策。 首先，我们将使用一系列丰富的数据集和结果，从获取 非医疗用途的处方阿片类药物芬太尼和海洛因。我们进一步制定措施， 这些相互关联的市场是各种药物替代范围的可能决定因素。第二、 我们将制定治疗措施。由于处方药的供应大幅减少， 滥用，个人可能替代其他药物或可能寻求治疗，以及额外的治疗可用性 可能会导致个人选择治疗，而不是替代海洛因。我们会研究十字架- 地方类阿片市场（按类型分列）与获得治疗机会之间的部门和时间关系 了解市场准入的反应能力。最后，我们将研究专业的异质性效应。 根据我们对当地市场成熟度和治疗机会的衡量，制定针对阿片类药物的政策。我们 将专注于采用“必须访问”PDMP，药丸厂打击，奥施康定的重新制定， 奥帕纳的重组这些估计将提供有关具体的当地因素如何预测的证据 对阿片类药物政策的反应。

Project Summary Prescription opioids have been a primary driver of the opioid epidemic, but more recently, overdoses involving heroin and fentanyl have increased dramatically. These trends have not been uniform across the country, yet we have little understanding about the heterogeneous effects of federal and state policies which seek to curb the overdose rate. Many policies have been implemented to address the rise in opioid-related abuse including prescription drug monitoring programs (PDMPs), pill mill regulations, and federal encouragement of abuse- deterrent formulations. Recent research has suggested that these interventions may promote substitution from non-medical prescription opioid use to abuse of heroin and fentanyl, partially unravelling the benefits of these policies. This national-level evidence masks significant amounts of local heterogeneity. In this project, we will explore this heterogeneity to understand which types of communities will be most impacted by certain policies and which will experience such unintended consequences as individuals substitute to more harmful drugs. This evidence is critical for predicting the local ramifications of federal and state policies and for providing information to help mitigate such unintended harms. Our analysis focuses on two central factors that likely determine local impacts of federal and state policies. First, we will use a rich array of datasets and outcomes to fully-characterize local markets in terms of access to prescription opioids for nonmedical use, fentanyl, and heroin. We further develop measures of how interconnected these markets are as possible determinants of the scope for substitution across drugs. Second, we will create measures of treatment access. Given a large reduction in the availability of prescription drugs for misuse, individuals may substitute to other drugs or may seek treatment, and additional treatment availability could potentially lead individuals to choose treatment instead of substituting to heroin. We will study the cross- sectional and temporal relationship between local markets for opioids (by type) and treatment access to understand the responsiveness of access to markets. Finally, we will study the heterogeneous effects of major opioid-specific policies based on our measures of the maturation of local markets and treatment access. We will focus on the adoption of “must access” PDMPs, pill mill crackdowns, the reformulation of OxyContin, and the reformulation of Opana. The estimates will provide evidence about how specific local factors predict responsiveness to opioid policies.