Evaluating the effects of two federal policies on buprenorphine prescribing andopioid-related health outcomes

项目总结 美国继续努力应对史无前例的阿片类药物过量流行； 2016年，美国有超过4.2万人死于阿片类药物过量。尽管受到了全国的高度关注， 筹资和调集资源，阿片使用障碍的流行率和相关死亡率 利率继续上升。我们迫切需要有效的政策工具来遏制这一不断扩大的流行病。 美沙酮或丁丙诺啡等药物的药物辅助治疗(MAT)已被 被证明是治疗OUD的最有效的方法，但普遍未得到充分利用。增加访问权限 MAT是国家抗击这一流行病的关键战略，这导致了最近的联邦政策 改变。具体地说，2016年，有两项政策提高了丁丙诺啡处方的患者上限 100至275个合格的提供者，并允许合格的执业护士和医生助理 第一次给MAT开药。然而，这些政策的影响尚不清楚。 这项拟议的研究旨在评估这两项政策在加利福尼亚州的效果 使用几个全州范围的管理数据源的中断时间序列设计。具体来说，我们的目标是 评估这些政策对有资格开处方的提供者的数量和处方能力的影响 丁丙诺啡、实际丁丙诺啡处方和阿片类药物相关的健康结果，包括就诊 和死亡。 鉴于疫情的规模和扩大治疗的迫切需要，至关重要的是 我们了解这些政策的影响，以便为优先事项和未来的连接战略提供信息 个别患者接受治疗。拟议的研究以极高的成本效益利用了一套不同的现有 管理数据源。此外，这项研究将有助于确定以下方面的影响和限度 消除限制处方医生供应和能力的障碍的战略，从而告知需要和 开展平行努力，解决丁丙诺啡更广泛使用的其他障碍。 研究将与导师指导下的严格和有针对性的培训计划并行进行 两位杰出的研究人员和一位统计顾问。通过这次研究和培训，申请者的目标是 从流行病学、生物统计学和其他学科获得应用方法和工具的知识和技能 对政策、方案和干预措施进行严格评估；获得有效和 创新地使用大型行政数据集进行与阿片类药物有关的应用研究；并扩大 阿片类药物使用和相关后遗症研究方面的内容专长。所有的培训和研究都将进行 在加州大学伯克利分校和旧金山公共部门的校园里 Health，它提供了非常适合的学术和应用研究环境的组合 以促进申请人发展为独立研究人员。

PROJECT SUMMARY The United States continues to grapple with an unprecedented opioid overdose epidemic; there were more than 42,000 opioid overdose deaths in the United States in 2016. Despite significant national attention, funding, and mobilization of resources, the prevalence of opioid use disorder (OUD) and associated mortality rates continue to rise. We are in dire need of effective policy tools to curb this expanding epidemic. Medication-assisted treatment (MAT) with medications such as methadone or buprenorphine has been shown to be the most effective approach for treating OUD, but is widely underutilized. Increasing access to MAT is a key strategy in national efforts to combat the epidemic, which has led to recent federal policy changes. Specifically, in 2016, two policies increased the patient limit for MAT buprenorphine prescribing from 100 to 275 for qualified providers and allowed qualified nurse practitioners and physician assistants to prescribe the medication for MAT for the first time. However, the impacts of these policies are unknown. The proposed study aims to evaluate the effects of these two policies in the state of California with an interrupted time series design using several state-wide administrative data sources. Specifically, we aim to evaluate the policies' effects on the number and prescribing capacity of providers qualified to prescribe buprenorphine, actual buprenorphine prescribing, and opioid-related health outcomes, including hospital visits and deaths. Given the scale of the epidemic and the urgent need for expanded treatment availability, it is critical that we understand the effects of these policies so as to inform priorities and future strategies for connecting individuals to treatment. The proposed research makes highly cost-effective use of a diverse set of existing administrative data sources. Furthermore, the study will help to establish the impact, as well as the limits, of strategies that remove barriers limiting the supply and capacity of prescribers, and thus inform the need and development of parallel efforts addressing other barriers to wider buprenorphine utilization. The research will be conducted in parallel with a rigorous and targeted training plan under the mentorship of two eminent researchers and a statistical consultant. Through this research and training, the applicant aims to gain knowledge and skills to apply methods and tools from epidemiology, biostatistics, and other disciplines to the rigorous evaluation of policies, programs and interventions; to gain the capacity to make effective and innovative use of large administrative datasets to conduct applied opioid-related research; and to expand content expertise in the study of opioid use and related sequelae. All training and research will be conducted across the campuses of the University of California, Berkeley and the San Francisco Department of Public Health, which provide a combination of academic and applied research environments that is excellently suited for facilitating the applicant's development into an independent researcher.