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

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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.