Department of Sociology, Ohio State University, Columbus (Vuolo); Department of Sociology, Purdue University, West Lafayette, Ind. (Kelly).
Am J Psychiatry. 2022 Apr;179(4):305-311. doi: 10.1176/appi.ajp.2021.21060602. Epub 2021 Dec 8.
The authors examined directly whether county-level changes in opioid dispensing rates affect individual-level prescription opioid misuse, frequency of use, and dependence, as well as the same outcomes for heroin.
Using data from the restricted-access National Survey on Drug Use and Health, the Centers for Disease Control and Prevention's retail opioid prescription database, the Prescription Drug Abuse Policy System, and the U.S. Census, the authors applied fixed-effects models to determine whether county-level dispensing rates affected prescription opioid outcomes as intended and whether changes in rates adversely affected heroin use outcomes. Bayes factors were used to confirm evidence for null findings.
The sample included 748,800 respondents age 12 and older from 2006 to 2016. The odds of prescription opioid misuse, increased frequency of misuse, and dependence were 7.2%, 3.5%, and 10.4% higher, respectively, per standard deviation increase in the county-level opioid dispensing rate per 100 persons. There was no evidence for any association between opioid dispensing rates and the three heroin outcomes. The odds ratio was nonsignificant according to frequentist techniques in fixed-effects models, and Bayesian techniques confirmed very strong support for the null hypothesis.
County-level opioid dispensing rates are directly associated with individual-level prescription opioid misuse, frequency of misuse, and dependence. Changes in dispensing were not associated with population shifts in heroin use. Reductions in opioid dispensing rates have contributed to stemming prior increases in prescription opioid misuse while not adversely affecting heroin use. Physicians and other health care providers can take action to minimize opioid dispensing for tangible benefits regarding prescription opioid misuse without adverse effects on heroin use.
作者直接检验了县级处方类阿片类药物配给率的变化是否会影响个体层面的处方类阿片类药物滥用、使用频率和依赖，以及海洛因的同样结果。
作者使用受限访问的国家药物使用和健康调查、疾病控制和预防中心的零售类阿片类药物处方数据库、处方药物滥用政策系统和美国人口普查的数据，应用固定效应模型来确定县级配给率是否按预期影响处方类阿片类药物的结果，以及配给率的变化是否对海洛因使用结果产生不利影响。贝叶斯因子用于确认无效发现的证据。
样本包括 2006 年至 2016 年间年龄在 12 岁及以上的 748800 名受访者。每增加 100 人县级阿片类药物配给率标准偏差，处方类阿片类药物滥用、滥用频率增加和依赖的几率分别高出 7.2%、3.5%和 10.4%。没有证据表明阿片类药物配给率与三种海洛因结果之间存在任何关联。根据固定效应模型中的频繁技术，比值比无统计学意义，贝叶斯技术则强烈支持无效假设。
县级阿片类药物配给率与个体层面的处方类阿片类药物滥用、滥用频率和依赖直接相关。配给的变化与海洛因使用的人口转移无关。减少阿片类药物配给率有助于遏制先前处方类阿片类药物滥用的增加，而不会对海洛因使用产生不利影响。医生和其他卫生保健提供者可以采取行动，减少阿片类药物的配给，以减少处方类阿片类药物滥用的明显好处，而不会对海洛因使用产生不利影响。
