Effectiveness of Mandatory Prescription Drug Monitoring

描述（由申请人提供）：拟议项目的广泛、长期目标是制定有效的干预方案，以控制美国非故意处方药物过量的流行。具体目的是：(1)评估国家处方药监测项目（PDMPs）在减少处方药销售和消费方面的有效性；(2)评估各州PDMPs在减少处方药过量非故意死亡方面的有效性；(3)检验各州PDMPs与因非故意过量服用处方药而导致中毒死亡的可能性之间的关系。随着附表二药品的销售和消费显著增加，美国每年因处方药物过量而到急诊室就诊和意外死亡的人数自1999年以来增加了一倍以上。处方药过量每年夺去超过2.2万人的生命，已成为导致意外伤害死亡的第二大原因。先前的研究表明，大多数意外过量的发病率和死亡率可归因于非医疗使用阿片类镇痛药和苯二氮卓类药物，这些药物是从转移和“医生购物”中获得的。集中于医生和患者教育的预防计划不足以控制处方药过量的持续流行。2002年，美国联邦政府启动了哈罗德·罗杰斯拨款计划，以支持各州PDMPs的创建和改进。截至2010年1月，34个州已经建立了可操作的PDMPs，疾病控制和预防中心最近呼吁在全国范围内采用PDMPs。虽然药品管理方案是对处方药转移和滥用的一项主要政策干预，但其在减少非法交易和处方药滥用的有害后果方面的有效性尚未得到严格评价。本项目旨在检验三个假设：(1)PDMP的实施与处方药销售和消费的显著下降有关；(2) PDMP实施与非故意处方药物过量死亡率显著降低相关；(3) PDMP的实施与因非故意处方药过量而导致中毒死亡的可能性显著降低有关。这些假设将使用1999- 2008年报告自动化和综合订单系统的季度数据和多死因数据文件、线性混合效应模型和具有人口和社会经济因素调整和序列自相关的多水平个体反应模型进行检验。本文的研究结果可以为控制处方药过量流行的政策改革和完善提供急需的经验证据。

DESCRIPTION (provided by applicant): The broad, long term objective of the proposed project is to develop effective intervention programs for controlling the epidemic of unintentional prescription drug overdoses in the United States. The specific aims are: (1) to assess the effectiveness of state Prescription Drug Monitoring Programs (PDMPs) in reducing the sales and consumption of prescription drugs; (2) to assess the effectiveness of state PDMPs in reducing unintentional fatalities from prescription drug overdoses; and (3) to examine the association between state PDMPs and the likelihood that a poisoning death is due to unintentional prescription drug overdose. With a marked increase in the sales and consumption of Schedule II pharmaceuticals, the annual numbers of emergency department visits and unintentional deaths related to prescription drug overdoses in the United States have more than doubled since 1999. Claiming over 22,000 lives each year, prescription drug overdose has become the second leading cause of unintentional injury mortality. Previous studies have revealed that the majority of unintentional overdose morbidity and mortality are attributable to nonmedical use of opioid analgesics and benzodiazepines obtained from diversion and 'doctor shopping.' Prevention programs concentrated on physician and patient education have been inadequate to control the ongoing epidemic of prescription drug overdoses. The U.S. federal government in 2002 started the Harold Rogers grant program to support the creation and improvement of state PDMPs. As of January 2010, 34 states have established operational PDMPs, and the Centers for Disease Control and Prevention has recently called for the nationwide adoption of PDMPs. Although PDMPs represent a major policy intervention on the diversion and abuse of prescription drugs, their effectiveness in decreasing illegal transactions and detrimental consequences of prescription drug abuse has not been rigorously evaluated. The proposed project aims to test three hypotheses: (1) PDMP implementation is associated with significantly decreased sales and consumption of prescription drugs; (2) PDMP implementation is associated with significantly decreased mortality from unintentional prescription drug overdoses; and (3) PDMP implementation is associated with a significantly decreased likelihood that a poisoning death is due to unintentional prescription drug overdose. These hypotheses will be tested using quarterly data for the years 1999- 2008 from the Automation of Reports and Consolidated Orders System and the multi-cause-of-death data files, and the linear mixed effects model and multilevel individual response model with adjustment for demographic and socioeconomic factors and serial autocorrelation. Findings from the proposed research can provide much-needed empirical evidence for policy reform and improvement to control the epidemic of prescription drug overdoses. PUBLIC HEALTH RELEVANCE: Morbidity and mortality from unintentional drug overdose in the United States have more than doubled since 1999, mainly due to nonmedical use of opioid analgesics and benzodiazepines obtained through drug diversion and 'doctor shopping.' Physician and patient education programs have been inadequate to control the epidemic of prescription drug overdoses. The proposed project aims to evaluate the effectiveness of state Prescription Drug Monitoring Programs in reducing the sales and consumption of controlled substances and deaths from unintentional overdose of prescription drugs, and to provide scientific evidence for policy interventions on the ongoing epidemic.