Understanding the Impact of Opioid Policies on the Opioid Epidemic Using Graphical Causal Models and Causal Discovery

摘要

ABSTRACT This NIDA Mentored Research Scientist Career Development Award (K01) for Dr. Hawre Jalal, an Assistant Professor of Health Policy and Management at the University of Pittsburgh Graduate School of Public Health, will establish Dr. Jalal as a health decision scientist with expertise in the impact of opioid- related policies using advanced methods in causal analyses. The opioid epidemic is a modern public health crisis responsible for reduced quality of life, decreased productivity, and increased risk of chronic conditions and mortality. State opioid policies may have shaped the outcome of the epidemic by benefiting some groups while having unintended consequences on other groups, such as the impact of limiting opioid prescribing to treat legitimate pain. However, most prior studies of these policies have been limited by (1) focusing on a single policy at a time, (2) ignoring the time it may take for a policy to be implemented and effective, and (3) treating the policies as binary variables (yes/no) even though policies vary widely across states. The research proposed in this award focuses on rigorously evaluating the benefits and the unintended consequences of state-opioid policies, such as prescription drug monitoring programs, on important outcomes, such as opioid-related overdose deaths. We propose (1) to use state-of-the-art causal models and causal discovery algorithms to systematically search for causal influences of policy components on the observed outcomes of opioid use disorder (Aim 1), (2) to identify policy combinations that likely increase benefits and reduce harms (Aim 2), and (3) to reveal priority research areas in the policy space by conducting formal value of information (VOI) analysis (Aim 3). The scientific premise for this proposal is strong. Evaluation of opioid policies are one of the top priorities for the NIDA 2016-2020 strategic plan. This project draws on Dr. Jalal’s extensive quantitative training, and knowledge of the epidemiology of the opioid use disorder and overdose deaths. This work will extend Dr. Jalal’s scholarship into the field of policy evaluation while incorporating advanced methods of causal discovery from observational data in health services research. Dr. Jalal will thus engage in training and career development activities that focus on acquiring expertise in causal modeling and in the interpretation and assessment of licit and illicit opioid-related policies. Through mentorship from bioinformaticians, health decision scientists and policy and clinical experts, Dr. Jalal will also focus on applying training in these content areas to health policy research. This training plan complements the proposed research and will equip Dr. Jalal to establish an independent research program examining the broader impact of the various policies on outcomes, such as HIV and hepatitis.