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力，但最近，过量涉及 海洛因和芬太尼大幅增加。这些趋势在全国范围内还不是一致的 我们对联邦和州政策的不同影响知之甚少，这些政策试图遏制 过量服药率。已经实施了许多政策来解决与阿片类药物有关的滥用增加的问题，包括 处方药监测计划(PDMP)、药厂法规和联邦鼓励滥用- 威慑配方。最近的研究表明，这些干预措施可能会促进从 非医疗处方阿片类药物滥用海洛因和芬太尼，部分揭开了这些药物的好处 政策。这一国家级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特定政策的最大影响 当个人替代更有害的药物时，它将经历意想不到的后果。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上，这两个因素可能决定联邦和州政策的地方影响。 首先，我们将使用丰富的数据集和结果来全面描述当地市场的准入情况 非医疗用处方类阿片、芬太尼和海洛因。我们进一步制定措施，说明如何 这些相互关联的市场是跨药物替代范围的可能决定因素。第二, 我们将制定治疗准入措施。鉴于可获得的处方药数量大幅减少， 滥用时，个人可替代其他药物或寻求治疗，并可获得额外的治疗 可能会导致个人选择治疗，而不是替代海洛因。我们将研究十字架- 阿片类药物当地市场(按类型分列)与获得治疗机会之间的部门和时间关系 了解市场准入的响应性。最后，我们将研究主要因素的异质性效应。 根据我们对当地市场成熟和治疗准入的措施，制定针对阿片类药物的政策。我们 将重点放在通过“必须进入”的PDMP，打击药厂，重新配制奥施康定，以及 Opana的重新提法。这些估计将为具体的地方因素如何预测提供证据。 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.