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

摘要 这个NIDA指导研究科学家职业发展奖（K 01）的Hawre Jalal博士，一个 匹兹堡大学研究生院卫生政策和管理助理教授 公共卫生，将建立贾拉尔博士作为一个健康决策科学家与阿片类药物的影响， 在因果分析中使用先进的方法制定相关政策。 阿片类药物流行是一种现代公共卫生危机，导致生活质量下降， 生产力下降，慢性病和死亡风险增加。国家阿片类药物政策 可能通过使一些群体受益而影响了疫情的结果， 对其他群体的影响，例如限制阿片类药物处方治疗合法 痛苦然而，大多数先前的研究这些政策已被限制（1）集中在一个单一的政策 （2）忽视政策实施和有效所需的时间，（3）处理 尽管各州的政策差别很大，但政策仍是二元变量（是/否）。 该奖项中提出的研究重点是严格评估效益和 州阿片类药物政策（例如处方药监测计划）对患者造成的意外后果 重要的结果，如阿片类药物过量死亡。我们建议（1）使用最先进的 因果模型和因果发现算法，以系统地搜索政策的因果影响 （2）确定政策 可能增加效益和减少危害的组合（目标2），以及（3）揭示优先研究 通过进行正式的信息价值（VOI）分析（目标3）， 这一建议的科学前提是强有力的。对阿片类药物政策的评估是最重要的政策之一。 NIDA 2016-2020战略计划的优先事项。该项目借鉴了Jalal博士广泛的定量研究， 培训和阿片类药物使用障碍和过量死亡的流行病学知识。这项工作 将把贾拉尔博士的奖学金扩展到政策评估领域，同时结合先进的 从卫生服务研究的观察数据中发现因果关系的方法。贾拉勒博士将 参与培训和职业发展活动，重点是获得因果关系方面的专业知识 建模以及解释和评估合法和非法类阿片相关政策。通过 来自生物信息学家、健康决策科学家、政策和临床专家的指导，Jalal博士 还将注重将这些内容领域的培训应用于卫生政策研究。本培训计划 补充拟议的研究，并将装备贾拉尔博士建立一个独立的研究 该计划审查了各种政策对艾滋病毒和肝炎等结果的更广泛影响。

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.