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Drug Alcohol Depend. 2020 Sep 1;214:108137. doi: 10.1016/j.drugalcdep.2020.108137. Epub 2020 Jun 27.
Characterize the state of the science in opioid policy research based on a literature review of opioid policy studies.
We conducted a scoping review of studies evaluating the impact of U.S. state-level and federal-level policies on opioid-related outcomes published in 2005-2018. We characterized: 1) state and federal policies evaluated, 2) opioid-related outcomes examined, and 3) study design and analytic methods (summarized overall and by policy category).
In total, 145 studies were reviewed (79 % state-level policies, 21 % federal-level policies) and classified with respect to 8 distinct policy categories and 7 outcome categories. The majority of studies evaluated policies related to prescription opioids (prescription drug monitoring programs (PDMPs), opioid prescribing policies, federal regulation of prescription opioids, pain clinic laws) and considered policy impacts with respect to proximal outcomes (e.g., opioid prescribing behaviors). In total, only 29 (20 % of studies) met each of three key criteria for rigorous design: analysis of longitudinal data with a comparison group design, adjustment for difference between policy-enacting and comparison states, and adjustment for potentially confounding co-occurring policies. These more rigorous studies were predominately published in 2017-2018 and primarily evaluated PDMPs, marijuana laws, treatment-related policies, and overdose prevention policies.
Our results indicated that study design rigor varied notably across policy categories, highlighting the need for broader adoption of rigorous methods in the opioid policy field. More evaluation studies are needed regarding overdose prevention policies and policies related to treatment access. Greater examination of distal outcomes and potential unintended consequences are also warranted.
通过对阿片类药物政策研究文献的综述，描述阿片类药物政策研究的现状。
我们对 2005 年至 2018 年期间发表的评估美国州级和联邦级政策对阿片类相关结果影响的研究进行了范围综述。我们描述了：1）评估的州和联邦政策，2）研究中检查的阿片类相关结果，以及 3）研究设计和分析方法（总体和按政策类别进行总结）。
共审查了 145 项研究（79%的州级政策，21%的联邦级政策），并根据 8 个不同的政策类别和 7 个结果类别进行了分类。大多数研究评估了与处方阿片类药物相关的政策（处方药物监测计划（PDMP）、阿片类药物处方政策、联邦对处方阿片类药物的监管、疼痛诊所法），并考虑了政策对近端结果（例如阿片类药物处方行为）的影响。共有 29 项研究（占研究的 20%）符合严格设计的三个关键标准：使用具有对照组设计的纵向数据分析、调整政策实施州和对照组之间的差异，以及调整潜在的并发政策。这些更严格的研究主要发表在 2017 年至 2018 年，主要评估了 PDMP、大麻法、治疗相关政策和过量预防政策。
我们的结果表明，研究设计的严格性在政策类别之间存在显著差异，这突出表明需要在阿片类药物政策领域更广泛地采用严格的方法。需要更多关于过量预防政策和与治疗机会相关的政策的评估研究。还需要更深入地研究远端结果和潜在的意外后果。
