1 Department of Health Services, University of Washington, Seattle, WA, USA.
2 Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA.
Public Health Rep. 2019 Sep/Oct;134(5):567-576. doi: 10.1177/0033354919864362. Epub 2019 Jul 31.
High-risk opioid-prescribing practices contribute to a national epidemic of opioid-related morbidity and mortality. The objective of this study was to determine whether the adoption of state-level opioid-prescribing guidelines that specify a high-dose threshold is associated with trends in rates of opioid overdose hospitalizations, for prescription opioids, for heroin, and for all opioids.
We identified 3 guideline states (Colorado, Utah, Washington) and 5 comparator states (Arizona, California, Michigan, New Jersey, South Carolina). We used state-level opioid overdose hospitalization data from 2001-2014 for these 8 states. Data were based on the State Inpatient Databases and provided by the Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality, via HCUPnet. We used negative binomial panel regression to model trends in annual rates of opioid overdose hospitalizations. We used a multiple-baseline difference-in-differences study design to compare postguideline trends with concurrent trends for comparator states.
For each guideline state, postguideline trends in rates of prescription opioid and all opioid overdose hospitalizations decreased compared with trends in the comparator states. The mean annual relative percentage decrease ranged from 3.2%-7.5% for trends in rates of prescription opioid overdose hospitalizations and from 5.4%-8.5% for trends in rates of all opioid overdose hospitalizations.
These findings provide preliminary evidence that opioid-dosing guidelines may be an effective strategy for combating this public health crisis. Further research is needed to identify the individual effects of opioid-related interventions that occurred during the study period.
高危阿片类药物处方实践是导致全国阿片类药物相关发病率和死亡率流行的原因之一。本研究的目的是确定采用规定高剂量阈值的州级阿片类药物处方指南是否与处方类阿片药物、海洛因和所有阿片类药物的过量用药住院率趋势相关。
我们确定了 3 个指南州（科罗拉多州、犹他州、华盛顿州）和 5 个对照州（亚利桑那州、加利福尼亚州、密歇根州、新泽西州、南卡罗来纳州）。我们使用这 8 个州 2001-2014 年的州级阿片类药物过量用药住院数据。数据基于州内住院数据库，由医疗保健成本和利用项目（HCUP）、医疗保健研究与质量局通过 HCUPnet 提供。我们使用负二项式面板回归来模拟每年阿片类药物过量用药住院率的趋势。我们采用多基线差异-差异研究设计来比较指南后趋势与对照州的同期趋势。
对于每个指南州，与对照州的趋势相比，处方类阿片药物和所有阿片类药物过量用药住院率的指南后趋势均有所下降。处方类阿片药物过量用药住院率趋势的年平均相对百分比降幅在 3.2%-7.5%之间，所有阿片类药物过量用药住院率趋势的年平均相对百分比降幅在 5.4%-8.5%之间。
这些发现提供了初步证据，表明阿片类药物剂量指南可能是应对这一公共卫生危机的有效策略。需要进一步研究以确定研究期间发生的与阿片类药物相关的干预措施的个别影响。
