Department of Pediatrics, Emory University School of Medicine.
Children's Healthcare of Atlanta.
Med Care. 2021 Feb 1;59(2):185-192. doi: 10.1097/MLR.0000000000001475.
The opioid overdose epidemic has been declared a public health emergency. Women are more likely than men to be prescribed opioid medications. Some states have adopted policies to improve opioid prescribing, including prescription drug monitoring programs (PDMPs) and pain clinic laws.
Among reproductive-aged women, we examined the association of mandatory use laws for PDMPs in Kentucky (concurrent with a pain clinic law) and New York with overdose involving prescription opioids or heroin and opioid use disorder (OUD).
STUDY DESIGN, SUBJECTS, AND OUTCOME MEASURES: We conducted interrupted time series analyses estimating outcome changes after policy implementation in Kentucky and New York, compared with geographically close states without these policies (comparison states), using 2010-2014 State Inpatient and State Emergency Department Databases. Outcomes included rates of inpatient discharges and emergency department visits for overdoses involving prescription opioids or heroin and OUD among reproductive-aged women.
Relative to comparison states, following Kentucky's policy change, we found an immediate postpolicy decrease and a decreasing trend in the rate of overdoses involving prescription opioids, an immediate postpolicy increase in the rate of overdoses involving heroin, and a decreasing trend in the OUD rate (P<0.01); New York's policy change was not associated with the assessed outcomes.
PDMPs and pain clinic laws, such as those implemented in Kentucky, may be promising strategies to reduce the adverse impacts of high-risk opioid prescribing among reproductive-aged women. As states continue efforts to improve inappropriate opioid prescribing, similar strategies as those adopted in Kentucky merit consideration.
阿片类药物过量已被宣布为公共卫生紧急事件。女性比男性更有可能被开阿片类药物。一些州已经采取了改善阿片类药物处方的政策，包括处方药物监测计划（PDMP）和疼痛诊所法。
在生育年龄的女性中，我们研究了肯塔基州（与疼痛诊所法同时实施）和纽约州强制性使用 PDMP 法与涉及处方阿片类药物或海洛因的过量用药和阿片类药物使用障碍（OUD）之间的关联。
研究设计、对象和结果测量：我们使用 2010-2014 年的州住院和州急诊部数据库，进行了中断时间序列分析，以估计肯塔基州和纽约州政策实施后的结果变化，并与没有这些政策的地理位置相近的州（比较州）进行了比较。结果包括生育年龄妇女因涉及处方阿片类药物或海洛因和 OUD 的住院和急诊部门就诊的出院率和就诊率。
与比较州相比，在肯塔基州政策变化后，我们发现涉及处方阿片类药物的过量用药率立即出现政策后下降趋势，涉及海洛因的过量用药率立即出现政策后上升趋势，以及 OUD 率呈下降趋势（P<0.01）；纽约州的政策变化与评估结果无关。
PDMP 和疼痛诊所法，如肯塔基州实施的那些，可能是减少生育年龄妇女高危阿片类药物处方不良影响的有前途的策略。随着各州继续努力改善不适当的阿片类药物处方，类似于肯塔基州采用的类似策略值得考虑。
