Policies to Inform Safe and Equitable Opioid Access for Patients with Advanced Cancer Near End of Life

为临近生命尽头的晚期癌症患者提供安全和公平的阿片类药物使用政策

• 批准号: 10733495
• 负责人: Lindsay Marie Sabik
• 金额: $ 40万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-01 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10733495
• 关键词: Policies; Inform; Safe; Equitable; Opioid

PROJECT SUMMARY/ABSTRACT For patients with advanced cancer, pain is a common and disabling symptom for which opioids remain a mainstay of treatment. The current epidemic of opioid misuse and addiction has led to widespread changes in opioid-related policies, including prescription drug monitoring programs (PDMPs) and laws limiting dose and duration of opioid prescriptions. Many such policies exclude patients with cancer; however, recent declines in opioid prescribing by oncologists and opioid use among patients dying of cancer highlight potential unintended consequences of opioid prescribing policies. Of particular concern is the potential impact on patients who are Black, low-income, elderly or reside in rural areas, since these groups are already at highest risk for inadequate pain treatment. To date, the impacts of opioid prescribing policies on patients with advanced cancer near end of life are not well understood. This represents a critical knowledge gap because understanding impacts of opioid-limiting legislation for patients with advanced cancer is essential to inform policies that effectively confront the dual public health crises of opioid misuse and inadequate pain treatment. This project investigates how state-level opioid policies can be structured to ensure safe and equitable opioid access for the roughly 600,000 adults who die from cancer annually in the United States. We will use over 10 years of claims data from Optum for national samples of patients with advanced breast, lung, and colorectal cancers near end of life. Patient data will be merged with detailed quarterly state policy data, which will be updated and synthesized with expert stakeholder input. In particular, we will examine the intended and unintended consequences of mandatory PDMP query laws, opioid prescribing cap laws limiting the dose/duration of opioid prescriptions, and state-specific cancer-related exemptions impacting opioid fills on patterns of use and pain-related outcomes. We will further investigate how state policy responses have impacted disparities in these outcomes. Finally, we will draw on stakeholder expertise to triangulate quantitative findings and inform policy recommendations. Our specific aims are to (1) assess impacts of state- level opioid prescribing policies on opioid access and end-of-life cancer pain management across a diverse national sample of decedents with advanced cancer using difference-in-difference models; (2) examine heterogeneity of policy impacts, with a focus on historically underserved patient groups; and (3) engage a stakeholder panel to inform, synthesize, and augment findings from Aims 1 and 2 and develop policy recommendations. This research will be the first analysis combining claims and policy data to comprehensively assess effects of state-level policies on opioid access, safety, and equity in this population. It will have a high impact because it will clarify impacts of wide-reaching opioid legislation for the more than 600,000 Americans who die annually with advanced cancer.

项目摘要/摘要 对于晚期癌症患者，疼痛是一种常见的致残症状，阿片类药物仍然是一种 治疗中流砥柱。目前阿片类药物滥用和成瘾的流行导致了 与阿片类药物相关的政策，包括处方药监测计划(PDMP)和限制剂量和 阿片类药物处方的持续时间。许多这样的政策将癌症患者排除在外；然而，最近 肿瘤学家开出的阿片类药物处方和癌症死亡患者的阿片类药物使用凸显了潜在的意外 阿片类药物处方政策的后果。尤其令人担忧的是，这可能会对那些 黑人、低收入、老年人或居住在农村地区，因为这些群体已经处于患癌症的最高风险 疼痛治疗不足。迄今为止，阿片类药物处方政策对晚期糖尿病患者的影响 接近生命末期的癌症还没有得到很好的了解。这代表着一个关键的知识鸿沟，因为 了解阿片类药物限制立法对晚期癌症患者的影响至关重要 有效应对阿片类药物滥用和疼痛治疗不足的双重公共卫生危机的政策。 该项目调查如何构建国家一级的阿片类药物政策，以确保安全和公平的阿片类药物 在美国，每年约有60万成年人死于癌症。我们将使用超过10个 Optus为全国晚期乳腺癌、肺癌和结直肠癌患者样本提供的多年索赔数据 接近生命末期的癌症。患者数据将与详细的季度州政策数据合并，这将是 利用专家利益攸关方的意见进行更新和综合。特别是，我们将检查预期的和 强制性PDMP查询法律、阿片类药物处方限制上限法律的意外后果 阿片类药物处方的剂量/持续时间，以及影响阿片类药物的州特定癌症相关豁免 使用模式和与疼痛相关的结果。我们将进一步调查国家政策反应是如何 影响了这些结果的差异。最后，我们将利用利益相关者的专业知识来进行三角测量 量化调查结果并为政策建议提供信息。我们的具体目标是(1)评估国家- 关于阿片类药物获取和生命末期癌症疼痛管理的水平阿片类药物处方政策 全国晚期癌症患者样本的差异性模型；(2)检验 政策影响的异质性，重点放在历史上服务不足的患者群体；以及(3)参与 利益相关者小组，通报、综合和补充目标1和2的调查结果，并制定政策 建议。这项研究将是第一次将索赔和保单数据相结合的分析 评估国家一级政策对这一人群中阿片类药物获取、安全和公平的影响。它会有一个很高的 影响，因为它将澄清影响广泛的阿片类药物立法对60多万美国人的影响 他们每年都会死于晚期癌症。