Opioid policy scales: Developing composite measures to account for heterogeneous design and implementation of state opioid policies

项目摘要 阿片类药物滥用是美国的公共卫生危机。作为回应，政策制定者和社区官员 推出了一系列政策和倡议，包括努力a)促进更好的疼痛管理 减少可能导致过度使用、误用和阿片类药物使用障碍的阿片类止痛药处方的做法；b) 改善获得治疗和康复服务的机会，以及c)促进使用纳洛酮以减少阿片类药物过量 死亡率。虽然最近的研究有助于我们理解一些政策的影响，但研究 通常依赖于两种不同的政策风险敞口变量(例如，任何PDMP与没有)，但这些变量没有考虑到 在名义上相同的政策中，各州之间往往存在巨大的差异。因此，我们几乎没有经验。 具体政策实施的哪些组成部分和方面最有效的证据 减少阿片类药物滥用对公共健康的影响。此项目的目标是使用已建立的 制定和评估标准化综合政策量表的方法，量化具体情况下的差异 阿片类药物政策的构成和政策运作的特点。对于三项关键政策中的每一项， 我们将从调查文献和COPR的政策数据库开始，对政策进行全面的分类 这些组成部分以及各国如何实施这些组成部分的方面。然后我们将开发出 综合政策衡量标准，考虑到国家政策的具体组成部分以及 这些组成部分已经到位，使用了两种替代策略：1)使用有效性证据 来自对文献的系统回顾，以及2)使用使用已建立的在线修改的Delphi过程 以调查为基础的迭代方法，就政策组成部分的影响和执行情况征求专家反馈。我们 然后，我将使用大型辅助数据集单独评估策略规模与 衡量阿片类药物的结果，并测试我们的综合政策量表如何相互比较和 在解释力和估计效果方面的两种衡量标准。调查结果也将有助于确定 决定政策环境强弱的关键因素。通过制定政策范围，我们 还允许未来的研究在以下情况下从统计上说明阿片类药物政策环境的各个方面 审查其他政策的影响，这些政策也可能影响阿片类药物的使用和结果。归根结底，这 研究议程将通过提供证据说明多维性质如何为公共卫生和政策提供信息 国家政策执行情况影响与阿片类药物相关的健康后果。

PROJECT ABSTRACT Opioid abuse is a public health crisis in the United States. In response, policymakers and community officials have launched range of policies and initiatives, including efforts to a) advance better pain management practices to reduce opioid analgesic prescribing likely to lead to overuse, misuse, and opioid use disorders; b) improve access to treatment and recovery services, and c) promote use of naloxone to reduce opioid overdose mortality. While recent research has contributed to our understanding of the impacts of some policies, studies have generally relied on dichotomous policy exposure variables (e.g., any PDMP vs. none) that fail to account for often dramatic between-state differences in nominally identical policies. Thus, we have little empirical evidence for which components and aspects of implementation of specific policies are most effective in reducing the public health consequences of opioid misuse. The goal of this project is to use established methods to develop and assess standardized composite policy scales that quantify variation in the specific components of opioid policies and characteristics of policy operationalization. For each of three key policies, we will begin by surveying the literature and COPR’s policy database to comprehensively catalogue policy components and aspects of how such components were implemented by states. We will then develop composite policy scales that account for the specific components of state policy as well as for the way in which the components have been put in place, using two alternative strategies: 1) using evidence on effectiveness from a systematic review of the literature, and 2) using online modified-Delphi processes that use established iterative survey-based methods to elicit expert feedback on policy component impact and implementation. We will then use large secondary data sets to separately estimate the association of the policy scales with measures of opioid outcomes, and to test how our composite policy scales compare to each other and to dichotomous measures in terms of explanatory power and estimated effects. Findings will also help to identify the key components that determine the strength of the policy environment. By developing policy scales, we also allow for future research to statistically account for aspects of the opioid policy environment when examining the impact of other policies that may also influence opioid use and outcomes. Ultimately, this research agenda will inform public health and policy by providing evidence of how the multidimensional nature of state policy implementation influences opioid-related health consequences.