Change in Opioid use and overdose after a medicaid lock-in program

描述（由申请人提供）：处方阿片类药物滥用是美国日益增长的公共卫生流行病，每年造成约15，000人死亡和超过550亿美元的社会成本。作为回应，各州越来越多地通过医疗补助锁定计划（MLIP）来管理CS滥用。北卡罗来纳州（NC）疼痛管理MLIP于2010年10月启动，旨在减少阿片类药物和抗焦虑药的欺诈性处方药，同时提高需要积极疼痛管理的患者的治疗连续性。该计划将符合条件的患者限制在一个供应商和一个药房12个月内。到目前为止，识别适合NC和其他MLIP的患者的算法主要基于州医疗补助人员的最佳临床判断。除了MLIP，NC还实施了受控物质报告系统（CSRS），该系统监控所有CS处方，无论付款人类型如何。将NC MLIP和CSRS的数据相结合，创造了一个独特的机会：（1）评估NC MLIP的实施情况，（2）检查NC MLIP中个人填写的CS处方的变化，无论保险公司如何。因此，我们建议在当前NC MLIP中检查利用和过量结局。具体目标#1，将通过与关键的药品持有人（项目管理员、医生和药剂师）的访谈来进行过程评估，以确定NC MLIP运行的环境。具体目标#2和#3将使用Medicaid索赔数据和CSRS检查NC MLIP对CS处方和处方者数量的影响，而具体目标#4检查NC MLIP对CS过量的影响。许多州将继续制定和实施诸如北卡罗来纳州的多边投资计划。对NC MLIP的严格评估对于为制定有效政策奠定基础至关重要，这些政策可以减少美国处方药滥用的破坏性后果。拟议的研究将利用一个独特而强大的数据库，以检查NC MLIP对CS使用和滥用的影响。这项研究的结果有可能大大降低CS滥用在人类生命和财政资源方面的成本。

DESCRIPTION (provided by applicant): Prescription opioid abuse is a growing public health epidemic in the US, contributing to an estimated 15,000 deaths and more than $55 billion in societal costs per year. In response, states are increasingly managing CS abuse with Medicaid Lock in Programs (MLIP). The North Carolina (NC) Recipient Management MLIP, initiated in October of 2010, was designed to reduce fraudulent prescription claims for opioids and anxiolytics, while improving continuity of treatment among patients needing aggressive pain management. The program limits eligible patients to a single provider and a single pharmacy for a 12 month period. To date, algorithms to identify patients appropriate for the NC and other MLIPs have been based primarily on the best clinical judgment of state Medicaid personnel. Separate from the MLIP, NC also implemented the Controlled Substances Reporting System (CSRS), which monitors all prescriptions for CS, regardless of payer type. Combining data from the NC MLIP and the CSRS creates a unique opportunity to: (1) assess the implementation of the NC MLIP and (2) examine changes in CS prescriptions filled among individuals in the NC MLIP, regardless of insurer. Therefore, we propose to examine utilization and overdose outcomes in the current NC MLIP. Specific Aim #1, will use interviews with key stakeholders-program administrators, physicians, and pharmacists-to perform a process assessment in order to determine the context in which the NC MLIP operates. Specific Aims #2 and #3 will use Medicaid claims data and the CSRS to examine the effect of the NC MLIP on the number of CS prescription and prescribers, while Specific Aim #4 examines the effect of the NC MLIP on CS overdose. MLIPs such as the one in NC will continue to be developed and implemented by many states. A rigorous evaluation of the NC MLIP is critical to building the foundation for developing effective policies that can reduce the devastating consequences of prescription drug abuse in the US. The proposed study will capitalize on a unique and powerful database to examine the effect of the NC MLIP on CS use and abuse. The results of this study have the potential to substantially reduce the cost of CS abuse in terms of human lives and financial resources.