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.

项目概要/摘要 对于晚期癌症患者来说，疼痛是一种常见的致残症状，阿片类药物仍然是一种常见的致残症状。 治疗的支柱。当前阿片类药物滥用和成瘾的流行导致了广泛的变化 阿片类药物相关政策，包括处方药监测计划 (PDMP) 和限制剂量和剂量的法律 阿片类药物处方的持续时间。许多此类政策将癌症患者排除在外；然而，最近的下降 肿瘤科医生开出的阿片类药物处方以及死于癌症的患者使用阿片类药物凸显了潜在的意外风险 阿片类药物处方政策的后果。特别值得关注的是对以下患者的潜在影响： 黑人、低收入群体、老年人或居住在农村地区的人，因为这些群体已经面临最高风险 疼痛治疗不足。迄今为止，阿片类药物处方政策对晚期患者的影响 生命即将结束时的癌症尚未得到充分了解。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患者至关重要 有效应对阿片类药物滥用和疼痛治疗不足双重公共卫生危机的政策。 该项目研究如何构建州级阿片类药物政策以确保安全和公平的阿片类药物 美国每年约有 600,000 名死于癌症的成年人。我们将使用 10 多个 Optum 多年来针对晚期乳腺癌、肺癌和结直肠癌患者全国样本的索赔数据 癌症接近生命的尽头。患者数据将与详细的季度国家政策数据合并，这些数据将 根据专家利益相关者的意见进行更新和综合。特别是，我们将检查预期和 强制性 PDMP 查询法、阿片类药物处方上限法限制的意外后果 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定癌症相关豁免 使用模式和疼痛相关的结果。我们将进一步研究国家政策反应如何 影响了这些结果的差异。最后，我们将利用利益相关者的专业知识来进行三角测量 定量研究结果并为政策建议提供信息。我们的具体目标是（1）评估国家的影响 不同领域的阿片类药物获取和临终癌症疼痛管理的阿片类药物处方政策 使用双重差分模型对患有晚期癌症的死者进行全国抽样； (2)检查 政策影响的异质性，重点关注历史上服务不足的患者群体； (3) 聘请 利益相关者小组通报、综合和增强目标 1 和 2 的调查结果并制定政策 建议。这项研究将是首次将索赔和保单数据结合起来进行全面分析 评估州级政策对该人群的阿片类药物获取、安全性和公平性的影响。它将有一个高 影响，因为它将阐明广泛的阿片类药物立法对超过 60 万美国人的影响 每年死于晚期癌症的人。