Assessing the Unintended Consequences of Restrictive Opioid Pain Reliever Policies

评估限制性阿片类止痛药政策的意外后果

• 批准号: 9225885
• 负责人: Ingrid A Binswanger
• 金额: $ 39.97万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-01 至 2018-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9225885
• 关键词: Assessing; Unintended; Consequences; Restrictive; Opioid

Overdoses from opioid pain relievers (OPR) have reached epidemic proportions in the United States. In response to this public health crisis, there have been local, state and national efforts to reduce inappropriate opioid prescribing. Recent small reductions in OPR deaths rates in 2012-3 suggest that these efforts may have been effective. However, unprecedented recent increases in heroin use, heroin use disorders, and heroin overdoses have also been observed. It has been suggested that efforts to curb inappropriate OPR prescribing are having the unintended consequence of increasing heroin use and its adverse events. Low cost and wide availability are common reasons provided for the switch from OPR to heroin use. To effectively manage the risk of heroin initiation, health systems, insurance plans, and medical providers need to understand whether, how, and for whom these risks are affected by OPR prescribing practices. Several policies in Colorado have been directed at curbing opioid prescribing. In August of 2014, Colorado Medicaid limited monthly quantities of short-acting opioid pills to 120. In February 2016, Medicaid limited the average daily covered morphine equivalent dose (MED) to 300 MED. Kaiser Permanente Colorado (KPCO) follows Medicaid's lead on opioid policy. These policies were intended to encourage providers to taper patients from high-dose opioid therapy, thus reducing the risk of OPR overdose. To date, however, the effect of these policies on physician prescribing behavior, OPR overdose, heroin use, and heroin overdose is not known. The overall goal of this project is to conduct a large, longitudinal cohort study to examine the impact of OPR policies and prescribing practices on heroin use and heroin overdose from 2012 to 2017. The study will include patients from a large managed care organization (Kaiser Permanente Colorado) and Colorado's Medicaid program. Together these systems cover approximately 2 million people in Colorado, representing 40% of the state's population. Exposures and outcomes, and covariates will be measured by linking patient-level data from pharmacy records, diagnoses, toxicology findings, health care utilization, and state vital records. Exposures and outcomes will be validated with medical record review. Analyses will be conducted with linear and nonlinear mixed effects regression models, with propensity scores to account for confounding. The results of these analyses will have implications for OPR prescribing policies at the state and national level.

阿片类止痛药（OPR）的过量剂量在美国达到了流行病。在 对这一公共卫生危机的回应，有地方，州和国家努力减少不适当的努力 阿片类药物处方。 2012 - 3年度OPR死亡率的最新降低表明，这些努力可能已经有 有效。但是，海洛因使用，海洛因使用障碍和海洛因的近期增长 还观察到过量药物。有人建议遏制不适当的OPR处方的努力 是海洛因使用及其不良事件的意想不到的后果。低成本和广泛 可用性是从OPR转换为海洛因使用的常见原因。有效管理 海洛因启动，卫生系统，保险计划和医疗提供者的风险需要了解，是否是否 如何以及这些风险受OPR处方实践影响。 科罗拉多州的几项政策旨在遏制阿片类药物处方。 2014年8月，科罗拉多州 医疗补助有限的每月短效阿片类药物至120。2016年2月，Medicaid Limited The 平均每日覆盖的吗啡当量剂量（MED）至300 MED。 Kaiser Permanente Colorado（KPCO） 遵循Medicaid在阿片类药物政策上的领导。这些政策旨在鼓励提供者锥形患者 通过大剂量阿片类药物疗法，从而降低了OPR过量的风险。但是，迄今为止，这些影响 关于医师处方行为，OPR过量，海洛因使用和海洛因过量的政策尚不清楚。 该项目的总体目标是进行大型的纵向队列研究以检查OPR的影响 从2012年到2017年，有关海洛因使用和海洛因过量的政策和规定实践。该研究将包括 来自大型托管护理组织（Kaiser Permanente Colorado）和科罗拉多州医疗补助的患者 程序。这些系统共同覆盖了科罗拉多州约200万人，占40％ 州的人口。暴露和结果以及协变量将通过将患者级数据从 药房记录，诊断，毒理学发现，医疗保健利用和州至关重要的记录。暴露 并将通过病历审查来验证结果。分析将以线性和 非线性混合效应回归模型，具有倾向得分以解释混淆。结果 这些分析将对州和国家一级的OPR处方政策产生影响。