Unintentional Prescription Opioid Poisoning Deaths in Connecticut and Rhode Islan

描述（由申请人提供）： 拟议的项目是响应本FOA的研究目标#4和#5：评估可能影响处方药过量率上升的政策或环境的最新变化（#4），并使用二次数据分析为处方药过量预防的政策辩论提供信息（#5）。目的：该提案的总体目标是探索康涅狄格州（CT）和罗得岛（RI）两个全州处方监测项目（PMP）在减少成人处方阿片类药物意外中毒死亡方面的效用和有效性。重要性：除了执法应用外，PMP作为一种结构性公共卫生干预措施，可以影响药物的转移和获得，并作为独特的公共卫生数据的生成器，在减少过量死亡方面可能具有更广泛的用途。这项研究的结果将有助于了解PMP目前的使用情况及其在处方阿片类药物过量监测和预防方面的潜力。具体目标：（目的1）通过在CT和RI的成人中进行匹配的病例对照研究，确定PMP数据是否可以检测阿片类药物转移和阿片类药物异常使用与处方阿片类药物意外过量死亡风险之间的相关性。我们将首先：（目标1a）完善阿片类药物异常使用的定义（即，（目标1b）对法医案例进行法医案例调查，以确定案例和对照;（目标2）：评估目前是否正在通过以下方式使用州PMP来检测过量风险：（目标2a）对处方者和配药者进行关于PMP使用情况的在线调查，以及（目标2b）检查处方阿片类药物过量死亡者居住地的地理分布、PMP的使用和社区中处方阿片类药物的数量之间的关联;和（目标3）进行快速评估和响应（RAR），以验证PMP和其他数据源生成的数据反映了两个社区（一个在RI，一个在CT）的高处方阿片类药物过量风险，并确定PMP和其他响应可用于预防致命处方阿片类药物过量的方法。研究设计：a）病例对照分析，B）横断面调查，和c）RAR人种学调查。环境/参与者：a）2009年期间在CT和RI发生的所有涉及药物的成人死亡，这些死亡来自州法医办公室数据库，也出现在PMP数据库中。案例将是涉及处方阿片类药物作为唯一阿片类药物的意外中毒死亡。对照将是任何意图的药物相关死亡，与年龄组、居住县和死亡月份的病例相匹配。B）将调查注册使用CT PMP的CT临床医生（n=1400）和药剂师（n=210）、上传处方数据的RI药房（n=200）和RI许可提供者（n=7955）。c）两个城市/城镇，一个在RI，一个在CT，经历了致命的处方阿片类药物过量的高比率。发言：无。结局指标：1）致命的处方阿片类药物过量事件; 2）处方阿片类药物的转移; 3）医生/药房购物; 4）提供者使用PMP（自我报告，行政记录）; 5）社区验证：处方阿片类药物过量问题定义和PMP的潜在预防益处。 公共卫生相关性： 处方监测计划（PMP）可能对患者、处方医生、药剂师、决策者和社会具有更广泛的效用，既可以作为一种结构性公共卫生干预形式，影响药物的转移和获取，也可以作为独特的公共卫生数据来源。这项研究将有助于了解PMP数据的潜在公共卫生应用，以减少意外致命的处方阿片类药物过量，通过医学检查员，PMP和康涅狄格州和罗得岛的其他州机构数据的联系，并通过在两个新英格兰社区进行基于社区的实地调查发现处方药物过量死亡率高。

DESCRIPTION (provided by applicant): The proposed project is responsive to research objectives #4 and #5 of this FOA: to evaluate recent changes in policies or environments that could influence the rising rate of prescription drug overdoses (#4), and to inform policy debate on prescription drug overdose prevention using secondary data analyses (#5). Objectives: The overarching goal of this proposal is to explore the utility and effectiveness of two statewide prescription monitoring programs (PMPs), in Connecticut (CT) and Rhode Island (RI), in reducing prescription opioid-involved accidental intoxication deaths among adults. Importance: Beyond their law enforcement application, PMPs may have broader utility in reducing overdose deaths as a form of structural public health intervention that can influence diversion and access to medications and as a generator of unique public health data. Results from this research will help understand how PMPs are currently being used and their potential for prescription opioid overdose surveillance and prevention. Specific Aims: (Aim 1) To determine if PMP data can detect an association between opioid diversion and aberrant opioid utilization and risk of prescription opioid accidental overdose death by conducting a matched case-control study among adults in CT and RI. We will first: (Aim 1a) refine the definition of aberrant opioid utilization (i.e., doctor shopping) using prescription "fill" data compiled by PMPs; and (Aim 1b) perform a forensic case investigation of medical examiner cases to identify cases and controls; (Aim 2): To assess whether state PMPs are, at present, being used in a way to detect overdose risk by: (Aim 2a) conducting an online survey of prescribers and dispensers on use of the PMP and (Aim 2b) examining associations between the geographic distribution of residence of decedents of prescription opioid overdose, use of the PMP, and the amount of prescribed opioid dispensed in the community; and (Aim 3) To conduct a rapid assessment and response (RAR) to verify that PMPs and other data sources generate data reflective of high prescription opioid overdose risk in two communities, one in RI and one in CT, and to determine ways that PMPs and other responses can be used to prevent fatal prescription opioid overdose there. Study Design: a) Case-control analysis, b) cross-sectional survey, and c) RAR ethnographic investigation. Setting/Participants: a) all deaths involving drugs among adults occurring in CT and RI during 2009 from the state medical examiner's office databases who also appear in the PMP database. Cases will be those accidental intoxication deaths involving a prescription opioid as the only opioid. Controls will be drug-involved deaths of any intent, matched to the case on age group, county of residence, and month of death. b) CT clinicians (n=1400) and pharmacists (n=210) registered to use the CT PMP, RI pharmacies (n=200) who upload prescription data, and RI licensed providers (n=7955) will be surveyed. c) two cities/towns, one in RI and one in CT, experiencing high rates of fatal prescription opioid-involved overdose. Intervention: None. Outcome measures: 1) fatal prescription opioid overdose events; 2) diversion of prescription opioids; 3) doctor/pharmacy shopping; 4) use of PMP by providers (self-reported, administrative records); 5) community-verified: prescription opioid overdose problem definition and potential prevention benefit of PMP. PUBLIC HEALTH RELEVANCE: Prescription monitoring programs (PMPs) may have broader utility to patients, prescribers, pharmacists, decision makers and to society both as a form of structural public health intervention that can influence diversion and access to medications and as a source of unique public health data. This study will help understand the potential public health application of PMP data to reducing unintentional fatal prescription opioid overdose through linkage of medical examiner, PMP, and other state agency data in Connecticut and Rhode Island and by conducting community-based field investigations in two New England communities found to be experiencing high rates of prescription overdose death.