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 已经推出了一系列政策和举措，包括努力a）推进更好的疼痛管理 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镇痛药处方的做法; B） 改善获得治疗和康复服务机会，以及c）促进使用纳洛酮，以减少阿片类药物过量 mortality.虽然最近的研究有助于我们了解一些政策的影响， 通常依赖于二分的政策风险变量（例如，任何一个人与没有人），未能说明 在名义上相同的政策中，国家之间往往存在巨大的差异。因此，我们几乎没有经验 具体政策执行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的公共卫生后果。该项目的目标是利用现有的 制定和评估标准化综合政策尺度的方法， 阿片类药物政策的组成部分和政策实施的特点。对于三项关键政策中的每一项， 我们将开始调查文献和COPR的政策数据库，全面地对政策进行分类 各国如何执行这些组成部分的内容和方面。然后我们将开发 综合政策尺度，说明国家政策的具体组成部分，以及如何 这些组成部分已经到位，使用两种替代战略：1）使用有效性证据 从文献的系统回顾，2）使用在线修改德尔菲法，使用建立 以迭代调查为基础的方法，以征求专家对政策组成部分的影响和执行情况的反馈意见。我们 然后，将使用大型辅助数据集分别估计政策尺度与 阿片类药物结果的措施，并测试我们的复合政策尺度如何相互比较， 在解释力和估计效果方面的二分措施。调查结果还将有助于确定 决定政策环境强度的关键因素。通过制定政策尺度，我们 还允许未来的研究在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。最终这 研究议程将通过提供证据说明多层面性质如何影响公共卫生和政策， 国家政策的执行影响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.