Policies to Inform Safe and Equitable Opioid Access for Patients with Advanced Cancer Near End of Life

为临近生命尽头的晚期癌症患者提供安全和公平的阿片类药物使用政策

• 批准号: 10733495
• 负责人: Lindsay Marie Sabik
• 金额: $ 40万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-01 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10733495
• 关键词: Policies; Inform; Safe; Equitable; Opioid

PROJECT SUMMARY/ABSTRACT For patients with advanced cancer, pain is a common and disabling symptom for which opioids remain a mainstay of treatment. The current epidemic of opioid misuse and addiction has led to widespread changes in opioid-related policies, including prescription drug monitoring programs (PDMPs) and laws limiting dose and duration of opioid prescriptions. Many such policies exclude patients with cancer; however, recent declines in opioid prescribing by oncologists and opioid use among patients dying of cancer highlight potential unintended consequences of opioid prescribing policies. Of particular concern is the potential impact on patients who are Black, low-income, elderly or reside in rural areas, since these groups are already at highest risk for inadequate pain treatment. To date, the impacts of opioid prescribing policies on patients with advanced cancer near end of life are not well understood. This represents a critical knowledge gap because understanding impacts of opioid-limiting legislation for patients with advanced cancer is essential to inform policies that effectively confront the dual public health crises of opioid misuse and inadequate pain treatment. This project investigates how state-level opioid policies can be structured to ensure safe and equitable opioid access for the roughly 600,000 adults who die from cancer annually in the United States. We will use over 10 years of claims data from Optum for national samples of patients with advanced breast, lung, and colorectal cancers near end of life. Patient data will be merged with detailed quarterly state policy data, which will be updated and synthesized with expert stakeholder input. In particular, we will examine the intended and unintended consequences of mandatory PDMP query laws, opioid prescribing cap laws limiting the dose/duration of opioid prescriptions, and state-specific cancer-related exemptions impacting opioid fills on patterns of use and pain-related outcomes. We will further investigate how state policy responses have impacted disparities in these outcomes. Finally, we will draw on stakeholder expertise to triangulate quantitative findings and inform policy recommendations. Our specific aims are to (1) assess impacts of state- level opioid prescribing policies on opioid access and end-of-life cancer pain management across a diverse national sample of decedents with advanced cancer using difference-in-difference models; (2) examine heterogeneity of policy impacts, with a focus on historically underserved patient groups; and (3) engage a stakeholder panel to inform, synthesize, and augment findings from Aims 1 and 2 and develop policy recommendations. This research will be the first analysis combining claims and policy data to comprehensively assess effects of state-level policies on opioid access, safety, and equity in this population. It will have a high impact because it will clarify impacts of wide-reaching opioid legislation for the more than 600,000 Americans who die annually with advanced cancer.

项目摘要/摘要 对于晚期癌症患者，疼痛是一种常见且残疾的症状，阿片类药物仍然是 治疗中的支柱。当前的阿片类药物滥用和成瘾流行已导致广泛改变 阿片类药物相关的政策，包括处方药监测计划（PDMP）和限制剂量的法律和 阿片类药物处方的持续时间。许多这样的政策不包括癌症患者。但是，最近下降了 肿瘤学家的阿片类药物处方和死于癌症患者的阿片类药物使用突出了潜在的意外 阿片类药物处方政策的后果。特别关注的是对患者的潜在影响 黑色，低收入，老年人或居住在农村地区，因为这些群体已经处于最高风险的风险 疼痛治疗不足。迄今为止，阿片类药物处方政策对患者的影响 近乎生命的癌症尚不清楚。这代表了一个关键的知识差距，因为 了解阿片类药物限制立法对晚期癌症患者的影响对于告知 有效地面临阿片类药物滥用和疼痛治疗不足的双重公共卫生危机的政策。 该项目调查了如何制定州级阿片类药物政策以确保安全和公平的阿片类药物 每年在美国死于癌症的大约600,000名成年人的访问。我们将使用10多个 来自Optum的多年索赔数据针对患有晚期乳房，肺和结直肠病患者的国家样本 癌症几乎生命的尽头。患者数据将与详细的季度国家政策数据合并，这将是 已更新并与专家利益相关者的输入合成。特别是，我们将研究预期的 强制性PDMP查询法律的意外后果，阿片类药物规定的上限法律限制了 阿片类药物处方的剂量/持续时间，以及影响阿片类药物填充的州特异性癌症的豁免 使用模式和与疼痛有关的结果。我们将进一步调查国家政策的回应如何 影响这些结果的差异。最后，我们将利用利益相关者的专业知识来进行三角剖分 定量发现并为政策建议提供信息。我们的具体目的是（1）评估国家的影响 - 水平的阿片类药物处方有关阿片类药物获取和临终癌症疼痛管理的政策 使用差异差异模型的全国晚期癌症患者样本； （2）检查 政策影响的异质性，重点是历史上服务不足的患者群体； （3）参与 利益相关者小组可告知，合成和增强目标1和2的发现并制定政策 建议。这项研究将是结合索赔和政策数据以全面的分析 评估国家一级政策对该人群中阿片类药物获取，安全性和公平性的影响。它将有一个高 影响是因为它将阐明对超过60万美国人的广泛阿片类药物立法的影响 每年死于晚期癌症的人。