Evaluating Policy Interventions to Decrease Excessive and Risky Perioperative Opioid Prescribing

项目摘要 在美国，每年至少有1540万阿片类药物处方在手术护理期间提供。 过度和危险的围手术期阿片类药物处方模式很常见，并增加了阿片类药物的风险 过量，成瘾，转移和持续使用阿片类药物。为了减轻这些危害，政策制定者和支付者 大多数州都制定了政策，限制阿片类药物用于急性疼痛或要求临床医生审查 处方阿片类药物前的处方药监测计划数据库（Pestival使用授权）。迄今为止， 研究严格评估了这些政策在外科手术背景下的预期和非预期影响， 在乎在这项为期4年的研究中，我们将使用准实验方法来检查阿片类药物处方的影响 围手术期阿片类药物处方、高风险处方、阿片类药物相关不良反应 事件和患者报告的结局。首先，我们将使用商业、医疗保险和医疗补助索赔数据库 为了评估国家阿片类药物处方限制的影响，并评估政策特征、患者 人群、程序和处方者（目标1）。第二，我们将评估国家使用汞的影响， 并使用相同的索赔数据库检查效应的异质性（目标2）。最后，我们将确定 密歇根州一家主要保险公司阿片类药物处方限制和密歇根州阿片类药物使用授权的影响 处方和术后患者报告的结果，使用全州登记处之间的新联系， 外科手术患者和国家数据库（目标3）。我们的研究结果将直接为减轻 围手术期阿片类药物处方的发病率以及优化未来所需的关键知识差距 政策设计例如，如果阿片类药物处方限制和阿片类药物使用规定减少了围手术期 阿片类药物处方，最小的意外影响，政策制定者应考虑实施这些政策 更广泛地说。然而，如果这些政策没有减少围手术期阿片类药物处方或有大量的 可能需要其他方法。最终，这一建议将有助于发展 设计良好的政策，平衡安全阿片类药物处方的需要与有效的 术后疼痛管理

PROJECT SUMMARY At least 15.4 million opioid prescriptions in the United States are provided each year during surgical care. Excessive and risky perioperative opioid prescribing patterns are common and increase the risk of opioid overdose, addiction, diversion, and persistent opioid use. To mitigate these harms, policymakers and payers in most states have enacted policies that restrict opioid prescribing for acute pain or mandate clinicians to review prescription drug monitoring program databases before prescribing opioids (PDMP use mandates). To date, few studies have rigorously assessed the intended and unintended effects of these policies in the context of surgical care. In this 4-year study, we will use quasi-experimental methods to examine the impact of opioid prescribing limits and PDMP use mandates on perioperative opioid prescribing, high-risk prescribing, opioid-related adverse events, and patient-reported outcomes. First, we will use commercial, Medicare, and Medicaid claims databases to evaluate the effect of state opioid prescribing limits and to assess variation in effects by policy feature, patient population, procedure, and prescriber (Aim 1). Second, we will evaluate the effect of state PDMP use mandates and examine heterogeneity in effects using the same claims databases (Aim 2). Finally, we will determine the impact of a major Michigan insurer’s opioid prescribing limit and Michigan’s PDMP use mandate on opioid prescribing and patient-reported outcomes after surgery, using a novel linkage between a statewide registry of surgical patients and the state PDMP database (Aim 3). Our findings will directly inform efforts to mitigate morbidity from perioperative opioid prescribing and close critical knowledge gaps needed to optimize future policy design. For example, if opioid prescribing limits and PDMP use mandates have reduced perioperative opioid prescribing with minimal unintended effects, policymakers should consider implementing these policies more broadly. However, if the policies have not reduced perioperative opioid prescribing or have had substantial unintended effects, other approaches may be needed. Ultimately, this proposal will contribute to the development of well-designed policies that balance the need for safe opioid prescribing with the need for effective postoperative pain management.