Evaluating Policy Interventions to Decrease Excessive and Risky Perioperative Opioid Prescribing

项目总结 在美国，每年至少有1540万张阿片类药物处方在外科治疗期间提供。 围手术期过量和危险的阿片类药物处方模式很常见，并增加了阿片类药物的风险 过量、上瘾、转移注意力和持续使用阿片类药物。为了减轻这些损害，政策制定者和支付者在 大多数州都颁布了限制阿片类药物处方治疗急性疼痛的政策，或强制要求临床医生审查 阿片类药物处方前的处方药监测计划数据库(PDMP使用规定)。到目前为止，几乎没有人 研究已经严格评估了这些政策在外科手术中的预期和非预期影响 关心。在这项为期4年的研究中，我们将使用准实验方法来检查阿片类药物处方的影响 围手术期阿片类药物处方、高风险处方、阿片类药物相关不良反应的限制和PDMP使用规定 事件和患者报告的结果。首先，我们将使用商业、医疗保险和医疗补助索赔数据库 评估国家阿片类药物处方限制的效果，并根据政策特征、患者评估效果的差异 人口、程序和处方者(目标1)。第二，我们将评估州PDMP使用命令的影响 并使用相同的索赔数据库检查效果的异质性(目标2)。最后，我们将确定 密歇根州一家主要保险公司的阿片类药物处方限制和密歇根州PDMP使用规定对阿片类药物的影响 手术后处方和患者报告的结果，使用全州范围的登记之间的新联系 手术患者和州PDMP数据库(目标3)。我们的发现将直接为缓解 围手术期阿片类药物处方的发病率和填补关键知识缺口以优化未来 政策设计。例如，如果阿片类药物处方限制和PDMP使用要求减少了围手术期 阿片类药物处方将意外影响降至最低，政策制定者应考虑实施这些政策 更广泛地说。然而，如果政策没有减少围手术期阿片类药物的处方或有实质性的 为了避免意外影响，可能需要采取其他办法。最终，这项建议将有助于 设计良好的政策，平衡安全阿片类药物处方的需要和有效的 术后疼痛管理。

PROJECT SUMMARY At least 15.4 million opioid prescriptions in the United States are provided each year during surgical care. Excessive and risky perioperative opioid prescribing patterns are common and increase the risk of opioid overdose, addiction, diversion, and persistent opioid use. To mitigate these harms, policymakers and payers in most states have enacted policies that restrict opioid prescribing for acute pain or mandate clinicians to review prescription drug monitoring program databases before prescribing opioids (PDMP use mandates). To date, few studies have rigorously assessed the intended and unintended effects of these policies in the context of surgical care. In this 4-year study, we will use quasi-experimental methods to examine the impact of opioid prescribing limits and PDMP use mandates on perioperative opioid prescribing, high-risk prescribing, opioid-related adverse events, and patient-reported outcomes. First, we will use commercial, Medicare, and Medicaid claims databases to evaluate the effect of state opioid prescribing limits and to assess variation in effects by policy feature, patient population, procedure, and prescriber (Aim 1). Second, we will evaluate the effect of state PDMP use mandates and examine heterogeneity in effects using the same claims databases (Aim 2). Finally, we will determine the impact of a major Michigan insurer’s opioid prescribing limit and Michigan’s PDMP use mandate on opioid prescribing and patient-reported outcomes after surgery, using a novel linkage between a statewide registry of surgical patients and the state PDMP database (Aim 3). Our findings will directly inform efforts to mitigate morbidity from perioperative opioid prescribing and close critical knowledge gaps needed to optimize future policy design. For example, if opioid prescribing limits and PDMP use mandates have reduced perioperative opioid prescribing with minimal unintended effects, policymakers should consider implementing these policies more broadly. However, if the policies have not reduced perioperative opioid prescribing or have had substantial unintended effects, other approaches may be needed. Ultimately, this proposal will contribute to the development of well-designed policies that balance the need for safe opioid prescribing with the need for effective postoperative pain management.