美国阿片类药物配送的县级差异所产生的影响。

Implications of county-level variation in U.S. opioid distribution.

机构信息

Department of Health Policy, Vanderbilt University Medical Center, 2525 West End Ave., Suite 1200, Nashville, TN 37203, USA; Partnered Evidence-Based Policy Resource Center, VA Boston Healthcare System, Bldg. 9, 150 S. Huntington Ave., Boston, MA 02130, USA.

Partnered Evidence-Based Policy Resource Center, VA Boston Healthcare System, Bldg. 9, 150 S. Huntington Ave., Boston, MA 02130, USA; Department of Health Law, Policy & Management, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA.

出版信息

Drug Alcohol Depend. 2021 Feb 1;219:108501. doi: 10.1016/j.drugalcdep.2020.108501. Epub 2021 Jan 3.

DOI:10.1016/j.drugalcdep.2020.108501

PMID:33421805

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8115932/

Abstract

BACKGROUND

Prescription opioids accounted for the majority of opioid-related deaths in the United States prior to 2010, and continue to contribute to opioid misuse and mortality. We used a novel dataset to investigate the distributional patterns of prescription opioids, whether opioid pill volume was associated with opioid-related mortality, and whether early state Medicaid expansions were associated with either pill volume or opioid-related mortality.

METHODS

Data on opioid shipments to retail pharmacies for 2006-2013 were obtained from the U.S. Drug Enforcement Administration, and opioid-related deaths (ORDs) were obtained from the Centers for Disease Control and Prevention. We first compared characteristics of counties in the highest and lowest quartiles for per capita pill volume (PCPV). We used adjusted difference-in-differences regression models to identify factors associated with PCPV or ORDs, and whether early state Medicaid expansions were associated with either outcome. All models were estimated as linear regressions with standard errors clustered by county, and weighted by county population.

RESULTS

We found large geographic variations in opioid distribution, and this variation appears to be driven by differences in demographics, healthcare access, and healthcare supply. In adjusted models, a one-pill increase in PCPV was associated with a 0.20 increase in ORDs per 100,000 population (95 % CI 0.11-0.30). Early Medicaid expansions were associated with lower PCPV (-2.20, 95 % CI -2.97 to -1.43).

CONCLUSIONS

Our findings validate the relationship between PCPV and ORDs, identify important environmental drivers of the opioid epidemic, and suggest early state Medicaid expansions were beneficial in reducing opioid pill volume.

摘要

背景

2010 年之前，处方类阿片在美国的阿片类相关死亡中占大多数，并且继续导致阿片类药物滥用和死亡。我们使用新的数据集来研究处方类阿片的分布模式，调查阿片类药丸数量是否与阿片类相关死亡率有关，以及早期的州医疗补助计划扩展是否与药丸数量或阿片类相关死亡率有关。

方法

从美国毒品管制局获得了 2006 年至 2013 年零售药店的阿片类药物发货数据，并从疾病控制和预防中心获得了阿片类相关死亡（ORD）数据。我们首先比较了人均药丸数量（PCPV）最高和最低四分位数的县的特征。我们使用调整后的差异差异回归模型来确定与 PCPV 或 ORD 相关的因素，以及早期州医疗补助计划扩展是否与任何结果相关。所有模型均以线性回归进行估计，标准误差按县聚类，并按县人口加权。

结果

我们发现阿片类药物分布存在很大的地域差异，这种差异似乎是由人口统计学、医疗保健获取和医疗保健供应方面的差异驱动的。在调整后的模型中，PCPV 每增加一片，每 10 万人中 ORD 增加 0.20（95%CI0.11-0.30）。早期医疗补助计划扩展与 PCPV 降低有关（-2.20，95%CI-2.97 至-1.43）。