From the Violence Prevention Research Program, Department of Emergency Medicine, UC Davis School of Medicine, Sacramento, CA.
Society and Health Research Center, Facultad de Humanidades, Universidad Mayor, Santiago, Chile.
Epidemiology. 2019 Mar;30(2):212-220. doi: 10.1097/EDE.0000000000000950.
Prescription drug monitoring program are designed to reduce harms from prescription opioids; however, little is known about what populations benefit the most from these programs. We investigated how the relation between implementation of online prescription drug monitoring programs and rates of hospitalizations related to prescription opioids and heroin overdose changed over time, and varied across county levels of poverty and unemployment, and levels of medical access to opioids.
Ecologic county-level, spatiotemporal study, including 990 counties within 16 states, in 2001-2014. We modeled overdose counts using Bayesian hierarchical Poisson models. We defined medical access to opioids as the county-level rate of hospital discharges for noncancer pain conditions.
In 2010-2014, online prescription drug monitoring programs were associated with lower rates of prescription opioid-related hospitalizations (rate ratio 2014 = 0.74; 95% credible interval = 0.69, 0.80). The association between online prescription drug monitoring programs and heroin-related hospitalization was also negative but tended to increase in later years. Counties with lower rates of noncancer pain conditions experienced a lower decrease in prescription opioid overdose and a faster increase in heroin overdoses. No differences were observed across different county levels of poverty and unemployment.
Areas with lower levels of noncancer pain conditions experienced the smallest decrease in prescription opioid overdose and the faster increase in heroin overdose following implementation of online prescription drug monitoring programs. Our results are consistent with the hypothesis that prescription drug monitoring programs are most effective in areas where people are likely to access opioids through medical providers.
处方药物监测计划旨在减少处方类阿片类药物的危害；然而，人们对于哪些人群最能从这些计划中受益知之甚少。我们研究了在线处方药物监测计划的实施与与处方类阿片药物和海洛因用药过量相关的住院率之间的关系随时间如何变化，以及这种变化在各县贫困率和失业率水平以及获取阿片类药物的医疗水平上的差异。
我们进行了一项包含 16 个州的 990 个县的县级生态学、时空研究。我们使用贝叶斯分层泊松模型来对用药过量的数量进行建模。我们将获取阿片类药物的医疗水平定义为非癌症疼痛病症的县一级医院出院率。
在 2010-2014 年，在线处方药物监测计划与较低的处方类阿片药物相关住院率相关（2014 年的比率比=0.74；95%可信区间=0.69,0.80）。在线处方药物监测计划与海洛因相关住院率之间的关联也是负相关的，但在后期呈上升趋势。非癌症疼痛病症发病率较低的县，处方类阿片药物用药过量的下降幅度较小，海洛因用药过量的上升速度较快。在不同的贫困率和失业率的县水平之间没有观察到差异。
在实施在线处方药物监测计划后，非癌症疼痛病症发病率较低的地区处方类阿片药物用药过量的下降幅度最小，海洛因用药过量的上升速度最快。我们的研究结果与假设一致，即处方药物监测计划在那些人们更有可能通过医疗服务提供者获取阿片类药物的地区最为有效。
