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.

项目总结/摘要 对于晚期癌症患者来说，疼痛是一种常见的致残症状，阿片类药物仍然是一种有效的治疗方法。 治疗的支柱。目前阿片类药物滥用和成瘾的流行导致了广泛的变化， 阿片类药物相关政策，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。许多此类政策将癌症患者排除在外;然而， 肿瘤学家的阿片类药物处方和死于癌症的患者中的阿片类药物使用突出了潜在的意外 阿片类药物处方政策的后果。特别值得关注的是， 黑人、低收入者、老年人或居住在农村地区，因为这些群体已经处于最高风险， 疼痛治疗不足。到目前为止，阿片类药物处方政策对晚期乳腺癌患者的影响 人们对临终前的癌症还没有很好的了解。这是一个关键的知识差距，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双重公共卫生危机的政策。 该项目调查了如何构建州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，每年大约有60万成年人死于癌症。我们将使用超过10 来自Optum的晚期乳腺癌、肺癌和结直肠癌患者国家样本的年索赔数据 癌症接近生命的尽头患者数据将与详细的季度国家政策数据合并， 根据利益攸关方专家的意见进行更新和综合。特别是，我们将审查预期和 强制性药物查询法律的意外后果，阿片类药物处方上限法律限制 阿片类药物处方的剂量/持续时间，以及影响阿片类药物填充的州特定癌症相关豁免 使用模式和疼痛相关结果。我们将进一步研究国家政策的反应如何 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， 量化结果并为政策建议提供依据。我们的具体目标是：（1）评估国家的影响- 在不同的国家，阿片类药物获取和临终癌症疼痛管理的阿片类药物处方政策 使用差异中差异模型的晚期癌症死亡者的全国样本;（2）检查 政策影响的异质性，重点关注历史上服务不足的患者群体;（3） 利益攸关方小组，通报、综合和扩大目标1和2的调查结果，并制定政策 建议.这项研究将是第一个结合索赔和政策数据的分析， 评估州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。它将有一个高 影响，因为它将澄清广泛的阿片类药物立法对60多万美国人的影响 每年死于晚期癌症的人