State Laws and Prescription Drug Abuse

项目摘要 约6.3%的美国人口(12岁以上)在过去一年中滥用处方药。 在18-25岁的年轻人中，这一发病率几乎翻了一番。意外中毒死亡涉及 阿片类止痛药(最有可能被滥用的处方药物)在1999-2010年间增加了四倍多，现在 死亡人数超过了海洛因和可卡因死亡人数的总和。与Rx药物中毒有关的死亡人数超过摩托车 2009年，车祸是与伤害有关的死亡的主要原因。阿片类疼痛使用量的增加 缓解的部分原因是管理阿片类止痛药处方的法律放开 疼痛，引入新的和更积极的疼痛管理标准，以及新的 毒品。该项目将评估针对Rx药物滥用的关键国家倡议的影响。这些措施包括 强制性处方药监测计划(PDMP)，配药阶段的ID要求，以及 在开药前必须对患者进行体检。对于大多数州来说，处方医生和 PDMP中的配送器是自愿的，因此PDMP的使用率相当低，远远低于50%。 此外，关于这些政策的影响的研究非常有限，尽管 奥巴马政府和许多州卫生部门制定了这些计划。除了……之外 为了解决这一知识差距，该项目还将评估这些政策是否有无意的 在提高海洛因使用量方面的后果，过去年轻人的海洛因使用量增加了一倍多 五年了。在非法吸毒者中，Rx滥用的流行率仅次于大麻，每四个新的非法药物中就有一个 吸毒者开始他们的习惯，非医疗使用Rx药物。因此，以下形式的意外后果 随着国家计划减少Rx药物的供应，海洛因或其他非法药物的使用可能会更多。 或者，如果染上阿片成瘾的个人数量增加，积极的溢出效应也是可能的 从而减少了向海洛因或其他非法药物的过渡。五个互补的数据集将是 用于调查一系列自我报告和客观测量的Rx和 非法药物使用和与药物有关的健康后果。在采用这些倡议方面有相当大的差异 跨州和州内，包括在同一州内交错采用不同的政策，将是 在差异性(DD)研究设计内利用，以确定可信的因果关系。这个 模型将补充各种检查和敏感度分析，包括测试和调整 DD估计的基础假设，评估政策的加固效果，评估 累积效应，评估跨境溢出效应，以及评估不同的政策反应。这个 拟议的研究将提供迄今为止最全面的有效性和可能的研究 旨在遏制Rx药物转移的关键国家举措的意外后果。这些估计将产生 有价值的证据为政策制定者提供了有效减少Rx滥用的法规组合。

Project Summary About 6.3% of the US population (ages 12+) have misused prescription (Rx) drugs in the past year, with this prevalence almost double among young adults ages 18-25. Unintentional poisoning deaths involving opioid pain relievers (Rx drugs most likely to be abused) have more than quadrupled from 1999-2010, and now outnumber deaths from heroin and cocaine combined. Deaths related to Rx drug poisoning surpassed motor vehicle crashes as the leading cause of injury-related mortality in 2009. The increase in the use of opioid pain relievers is due in part to the liberalization of laws governing the prescription of opioid analgesics for chronic pain, the introduction of new and more aggressive pain management standards, and the availability of new drugs. This project will estimate the effects of key state initiatives targeting Rx drug abuse. These include mandatory prescription drug monitoring programs (PDMP), an ID requirement at the dispensing stage, and required physical exam of the patient prior to prescribing. For most states participation by prescribers and dispensers in the PDMP is voluntary, and hence PDMP utilization rates are quite low and well below 50%. Furthermore, there is very limited research on the effects of these policies despite recommendations by the Obama administration and many state health departments to institute these programs. In addition to addressing this knowledge gap, this project will also assess whether these policies have had unintended consequences in terms of raising heroin use, which has more than doubled among young adults over the past 5 years. Among illicit drug users, Rx abuse is second in prevalence only to marijuana, and 1 out of 4 new illicit drug users began their habit with non-medical use of Rx drugs. Thus, unintended consequences in the form of greater use of heroin or other illicit drugs may occur as availability of Rx drugs is reduced by state programs. Alternatively, positive spillovers are also possible if the number of individuals who acquire an opioid addiction and consequently transition to heroin or other illicit drugs is reduced. Five complementary data sets will be utilized to investigate these policy effects across a range of self-reported and objectively measured Rx and illicit drug-use and drug-related health outcomes. Considerable variation in the adoption of these initiatives across and within states, including staggered adoption of different policies within the same state, will be exploited within a difference-in-differences (DD) research design to identify credible causal effects. The models will be supplemented with various checks and sensitivity analyses, including testing and adjusting for the assumptions underlying the DD estimation, assessing reinforcement effects across the policies, assessing cumulative effects, assessing cross-border spillovers, and assessing heterogeneous policy responses. The proposed research will provide the most comprehensive study to date of the effectiveness and possible unintended consequences of key state initiatives aimed at curbing Rx drug diversion. These estimates will yield valuable evidence informing policymakers on the mix of regulations effective in reducing Rx abuse.