Assessing the impact of opioid prescription duration limits

项目摘要 到目前为止，33个州已经实施了处方持续时间限制，以打击国家 阿片类药物流行病这些政策的目的是尽量减少患者对阿片类药物的暴露， 减少依赖率、过量和昂贵的医疗保健利用。然而，限制 处方药供应可能会产生意想不到的不良后果，包括增加医疗保健 由于无法控制的疼痛而使用或自杀，以及使用非法的非处方物质（例如，海洛因， 非法制造的芬太尼）作为法定阿片类药物的替代品。尽管有这些 竞争性潜在影响，没有研究评估处方持续时间限制的影响 政策这项拟议中的研究将首次衡量这些政策对处方的影响 模式（目标1）、医疗保健使用（目标2）和健康结果（目标3）。最重要的是，我们将评估 这些政策的有意和无意--但可能是可怕的--影响。我们将解决 通过使用创新的“剂量反应”事件研究方法来弥补这一重要的知识差距。 特别是，我们将比较更“暴露”于政策的地区（县）的结果， 那些暴露较少的地区。我们将相对暴露定义为阿片类药物处方率， 在政策实施前，超过政策规定的供应天数限制。这种方法有一个 与其他方法相比的重要优势：我们能够区分将被 不成比例地受到持续时间限制的影响（具体基于天数供应）， 其它阿片样物质特异性度量（例如，处方数量），这可能会受到 其他阿片类药物减少政策。这使我们能够单独隔离持续时间限制的影响， 其他方法学方法，由于许多其他与阿片类药物有关的 已经实施的政策。该研究的数据来自西弗吉尼亚州（WV）， 肯塔基州（KY）医疗补助索赔。由于WV和KY有不同的持续时间限制，我们将 能够直接比较更严格与更宽松政策的影响。本研究结果 将为公共卫生政策和临床实践提供急需的证据 在美国各地。这项研究与NIDA对提供者和健康的研究重点保持一致 预防药物滥用的系统方法。

PROJECT ABSTRACT To date, 33 states have implemented prescription duration limits to combat the national opioid epidemic. The intention of these policies is to minimize patient exposure to opioids, thereby reducing dependence rates, overdoses, and costly health care utilization. However, limiting prescription supply may have unintended adverse consequences, including increased health care use or suicide due to uncontrolled pain, and use of illicit non-prescription substances (e.g., heroin, illegally manufactured fentanyl) as a substitute for legally-prescribed opioids. Despite these competing potential impacts, no study has assessed the impact of a prescription duration limit policy. The proposed study will be the first to measure the impact of these policies on prescription patterns (Aim 1), health care use (Aim 2), and health outcomes (Aim 3). Crucially, we will assess both intended and unintended – yet potentially dire – impacts of these policies. We will address this important knowledge gap by using an innovative “dose response” event-study methodology. In particular, we will compare outcomes in areas (counties) more “exposed” to the policies to those in less exposed areas. We define relative exposure as the rate of opioid prescriptions that exceeded the policies’ limit on days’ supply, prior to policy implementation. This approach has an important advantage over other methods: we are able to distinguish between metrics that will be disproportionately targeted by duration limits (which is based specifically on days’ supply) versus other opioid-specific metrics (e.g., number of prescriptions), which are likely to be influenced by other opioid reduction policies. This allows us to isolate the impact of duration limits alone, unlike other methodological approaches, which may be biased due to the many other opioid-related policies that have been implemented. Data for the study come from West Virginia (WV) and Kentucky (KY) Medicaid claims. Because WV and KY have different duration limits, we will be able to directly compare the impact of stricter versus more lenient policies. Results from this study will provide urgently-needed evidence that will inform public health policy and clinical practice across the US. This study is firmly aligned with NIDA’s research emphasis on provider and health systems-based approaches to drug abuse prevention.