State Laws and Prescription Drug Abuse

项目摘要 在过去的一年里，大约6.3%的美国人口（12岁以上）滥用处方药， 在18 - 25岁的年轻人中，这一流行率几乎翻了一番。意外中毒死亡 阿片类止痛药（最有可能被滥用的Rx药物）从1999年到2010年增加了四倍多，现在 超过了海洛因和可卡因致死的总和与Rx药物中毒有关的死亡人数超过了机动车 车祸是2009年伤害相关死亡的主要原因。阿片类药物使用的增加 缓解药物的减少部分是由于管制阿片类镇痛药处方的法律的自由化， 疼痛，新的和更积极的疼痛管理标准的引入，以及新的 毒品该项目将评估针对Rx药物滥用的关键国家举措的影响。这些包括 强制性处方药监测计划（PIMs），在配药阶段的ID要求，以及 在开处方前需要对患者进行体格检查。对于大多数州，处方者参与， 由于公共图书馆中的配药员是自愿的，因此公共图书馆的使用率很低，远低于50%。 此外，尽管联合国人口基金提出了建议，但对这些政策的影响的研究非常有限。 奥巴马政府和许多州的卫生部门制定了这些计划。除了 为了解决这一知识差距，本项目还将评估这些政策是否产生了意想不到的效果， 在增加海洛因使用方面的后果，过去年轻人中的海洛因使用增加了一倍多 5年在非法药物使用者中，Rx滥用的流行率仅次于大麻， 吸毒者开始习惯于非医疗使用处方药。因此，意外后果的形式， 由于国家计划减少了Rx药物的可用性，可能会出现更多的海洛因或其他非法药物的使用。 或者，如果获得阿片类药物成瘾的人数增加， 从而减少向海洛因或其他非法药物的过渡。五个补充数据集将 用于调查这些政策的影响，在一系列自我报告和客观衡量的Rx和 非法药物使用和与药物有关的健康结果。在采取这些举措方面存在很大差异 跨州和州内，包括在同一州内交错采用不同的政策，将 在差异中的差异（DD）研究设计，以确定可信的因果关系。的 模型将补充各种检查和敏感性分析，包括测试和调整， DD估计的基本假设，评估政策的强化效应，评估 累积效应，评估跨境溢出效应，评估不同的政策反应。的 拟议的研究将提供迄今为止最全面的研究， 旨在遏制Rx药物转移的关键州举措的意外后果。这些估计将产生 有价值的证据，使决策者了解有效减少Rx滥用的各种法规。

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.