Prescription drug monitoring programs and opioid-related harm

 描述(申请人提供)：与药物使用有关的致命过量在过去30年中增加了近600%，现在是该国受伤死亡的主要原因。这一增长在很大程度上是由处方阿片类药物(PO)过量推动的，处方阿片类药物导致的死亡人数超过海洛因、可卡因和兴奋剂的总和。处方药监测计划(PDMP)是州级数据库，药房配药员在分发某些药物时必须向其报告处方信息，已被作为减少PO相关伤害的工具而发展。必须回答四个关键问题来确定PDMP是否能减少PO相关的危害：(1)PDMP对健康结果的影响是什么？虽然一些研究表明，使用最佳实践的PDMP在减少“医生购物”方面是有效的，但大多数现有研究没有检查PDMP在减少PO相关危害方面的作用，少数研究提出了不一致的结论。(2)PDMP特征的变化是否会影响结果？现有研究在很大程度上将PDMP的存在视为一个二元变量，而没有考虑PDMP运行特性中的状态变化，而这些状态变化已被专家推荐为“最佳实践”。(3)谁从港口及港口管理计划中获益最多？PDMP的好处可能集中在对POS有医疗需求的群体，以及更富裕地区的居民。这两个群体都更有可能通过其医疗提供者获得PO，并在PO相关伤害的情况下接受转诊至循证治疗。(4)pdmp是否会产生意想不到的负面结果？如果不作为减少阿片类药物相关危害的综合战略的一部分加以实施，与PDMP有关的处方的减少可能会导致滥用POS的人转向使用海洛因。在不太富裕的地区，转向使用海洛因可能是一个特别令人担忧的问题，这些地区与PO相关的伤害发生率较高，获得PO依赖的循证治疗的机会较低。本研究有两个目的：(1)检验PDMP“最佳实践”特征的实施与因PO过量(POD)和海洛因过量(HOD)而住院率变化的关系；(2)检验PDMP“最佳实践”特征的实施与POD和HOD之间的关系是否因人群的医疗需求和社会经济特征而不同。为了实现这些目标，将制定PDMP特征的类型学，包括报告的药物时间表的数量、数据报告的频率、主动向授权用户提供数据、用户培训、注册和数据获取的要求以及州际数据共享。医院住院患者过量用药数据将从医疗成本和利用项目中获得，地理编码为邮政编码级别。我们将在美国18个州测试PDMP特征的变化对因POD和HOD住院率的影响，这些州拥有PDMP运行一年的PDMP前后住院数据和异质性，以及1993-2014年间居住在这些州内13,512个邮政编码地区的人。

 DESCRIPTION (provided by applicant): Fatal overdoses related to drug use have increased nearly 600% in the past three decades, and are now the country's leading cause of injury death. This rise has been largely driven by prescription opioid (PO) overdoses, which account for more deaths than heroin, cocaine and stimulants combined. Prescription drug monitoring programs (PDMPs), state-level databases to which pharmacy dispensers must report prescription information when certain medications are dispensed, have been advanced as tools to reduce PO-related harm. Four critical questions must be answered to determine whether PDMPs reduce PO-related harm: (1) What is the impact of PDMPs on health outcomes? While some studies suggest that PDMPs using best practices are effective in reducing "doctor shopping", most existing research has not examined the role of PDMPs in reducing PO-related harm, and the few that have, present inconsistent findings. (2) Do variations in PDMP characteristics affect outcomes? Existing research largely treats presence of a PDMP as a binary variable, without considering state variation in PDMP operational characteristics that have been recommended by experts as "best practices". (3) Who benefits the most from PDMPs? The benefit of PDMPs is likely concentrated among groups with a medical need for POs, and residents of more affluent areas. Both of these groups are more likely to access POs through their medical providers, and to receive referrals to evidence- based treatment in the case of PO-related harm. (4) Can PDMPs have unintended negative outcomes? If not implemented as part of an integrated strategy to reduce opioid-related harm, the reduction in prescriptions associated with PDMPs could potentially lead to transition to heroin use among those who abuse POs. Transitions to heroin use may be a particular concern in less affluent areas, where rates of PO-related harm are higher, and access to evidence-based treatment for PO dependence is lower. This study has two aims: (1) to test the relation between implementation of"best practice" PDMP features and change in the rate of hospitalizations due to PO overdose (POD) and heroin overdose (HOD); and (2) to test whether the relationship between implementation of PDMP "best practice" characteristics and POD and HOD differed by medical need and socioeconomic characteristics of population groups. To address these aims, a typology of PDMP characteristics will be developed, including number of drug schedules reported, frequency of data reporting, proactive provision of data to authorized users, requirements for user training, registration, and data accessing, and interstate data sharing. Hospital inpatient overdose data geocoded to the zip code level will be obtained from the Healthcare Cost and Utilization Project. We will test the impact of variations in PDMP characteristics on rates of hospitalizations due to POD and HOD across 18 U.S. states with available pre- and post-PDMP hospitalization data and heterogeneity in the year of PDMP operation, and among persons living in 13,512 zip code areas within those states across 1993-2014.