Measuring the Presence of Opioid Markets in Local Communities and Their Impacts on Harm

衡量当地社区阿片类药物市场的存在及其对危害的影响

• 批准号: 10220923
• 负责人: David Powell
• 金额: $ 19.25万
• 依托单位: RAND CORPORATION
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-15 至 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10220923
• 关键词: Address; Adoption; Affect; Area; Cessation of life; Communities; Country; County; Cross-Sectional Studies; Data; Data Set; Development; Fentanyl; Firearms; Formulation; Geographic Locations; Health Services Accessibility; Heroin; Heroin Abuse; Heterogeneity; Individual; Intervention; Law Enforcement; Lead; Level of Evidence; Market Research; Masks; Measures; Mediating; Monitor; Opioid; Opioid Analgesics; Outcome; Overdose; Oxycodone; Pharmaceutical Preparations; Policies; Predictive Factor; Public Health; Regulation; Research; Research Personnel; Risk; Testing; Time; Variant; base; effective therapy; experience; federal policy; illicit opioid; innovation; interest; misuse of prescription only drugs; mortality; multiple data sources; opioid epidemic; opioid policy; pill; predict responsiveness; prescription monitoring program; prescription opioid; prescription opioid misuse; programs; trend; vehicular accident

Project Summary Prescription opioids have been a primary driver of the opioid epidemic, but more recently, overdoses involving heroin and fentanyl have increased dramatically. These trends have not been uniform across the country, yet we have little understanding about the heterogeneous effects of federal and state policies which seek to curb the overdose rate. Many policies have been implemented to address the rise in opioid-related abuse including prescription drug monitoring programs (PDMPs), pill mill regulations, and federal encouragement of abuse- deterrent formulations. Recent research has suggested that these interventions may promote substitution from non-medical prescription opioid use to abuse of heroin and fentanyl, partially unravelling the benefits of these policies. This national-level evidence masks significant amounts of local heterogeneity. In this project, we will explore this heterogeneity to understand which types of communities will be most impacted by certain policies and which will experience such unintended consequences as individuals substitute to more harmful drugs. This evidence is critical for predicting the local ramifications of federal and state policies and for providing information to help mitigate such unintended harms. Our analysis focuses on two central factors that likely determine local impacts of federal and state policies. First, we will use a rich array of datasets and outcomes to fully-characterize local markets in terms of access to prescription opioids for nonmedical use, fentanyl, and heroin. We further develop measures of how interconnected these markets are as possible determinants of the scope for substitution across drugs. Second, we will create measures of treatment access. Given a large reduction in the availability of prescription drugs for misuse, individuals may substitute to other drugs or may seek treatment, and additional treatment availability could potentially lead individuals to choose treatment instead of substituting to heroin. We will study the cross- sectional and temporal relationship between local markets for opioids (by type) and treatment access to understand the responsiveness of access to markets. Finally, we will study the heterogeneous effects of major opioid-specific policies based on our measures of the maturation of local markets and treatment access. We will focus on the adoption of “must access” PDMPs, pill mill crackdowns, the reformulation of OxyContin, and the reformulation of Opana. The estimates will provide evidence about how specific local factors predict responsiveness to opioid policies.

项目概要 处方阿片类药物一直是阿片类药物流行的主要驱动因素，但最近，过量服用阿片类药物 海洛因和芬太尼的数量急剧增加，但全国范围内的趋势并不一致。 我们对联邦和州政策的异质效应知之甚少，这些政策旨在遏制 已经实施了许多政策来解决与阿片类药物相关的滥用问题，包括 处方药监测计划 (PDMP)、药丸厂法规以及联邦政府对滥用的鼓励 - 最近的研究表明，这些干预措施可能会促进替代。 非医疗处方阿片类药物滥用海洛因和芬太尼，部分揭示了这些药物的好处 这一国家级证据掩盖了大量的地方异质性。 探索这种异质性，以了解哪些类型的社区将受到某些政策的影响最大 当人们使用更有害的药物时，将会产生意想不到的后果。 证据对于预测联邦和州政策对当地的影响以及提供信息至关重要 有助于减轻此类意外伤害的信息。 我们的分析重点关注可能决定联邦和州政策对当地影响的两个核心因素。 首先，我们将使用丰富的数据集和结果来全面描述当地市场的准入情况 我们进一步制定了非医疗用途处方阿片类药物、芬太尼和海洛因的措施。 这些市场相互关联，可能是药物替代范围的决定因素。 鉴于处方药供应量大幅减少，我们将制定治疗获取措施。 滥用，个人可能会替代其他药物或可能寻求治疗，以及额外的治疗可用性 可能会导致个人选择治疗而不是替代海洛因。 当地阿片类药物市场（按类型）与获得治疗的机会之间的部门和时间关系 最后，我们将研究主要因素的异质效应。 基于我们对当地市场成熟度和治疗可及性的衡量的阿片类药物具体政策。 将重点关注采用“必须获取”的 PDMP、打击药厂、重新制定奥施康定配方以及 Opana 的重新制定将提供有关具体当地因素如何预测的证据。 对阿片类药物政策的反应。