RAND Corporation Pittsburgh, PA, USA; University of Pittsburgh School of Medicine, USA.
RAND Corporation, Arlington, VA, USA.
Drug Alcohol Depend. 2022 Feb 1;231:109232. doi: 10.1016/j.drugalcdep.2021.109232. Epub 2021 Dec 28.
Multiple state policies, such as prescription drug monitoring programs (PDMPs) and duration limits, have been implemented to decrease high-risk opioid prescribing. Studies demonstrate that many policies decrease certain opioid prescribing behaviors, but few examine their intended effects on the targeted high-risk prescribing practices, nor disentangle the effects of concurrent state or federal policies likely to influence those practices.
Forty-one million initial prescriptions for new opioid episodes from 2007 to 2018 were identified using national pharmacy claims. We identified high-risk initial prescriptions, defined as >7 days' supply, average daily MME >90, or concurrent with benzodiazepines and estimated three multivariable logistic regression models to assess the association between policies and outcomes controlling for patient, prescriber, and county characteristics.
Initial prescriptions for >7 days declined from 23.8% in 2007 to 14.9% in 2018, associated with mandatory and interoperable PDMPs and prescription duration limits but not other policies examined. Initial prescriptions with daily MME > 90 declined from 13.2% to 1.9%, associated with pain management clinic laws but not consistently with other policies. Initial prescriptions concurrent with benzodiazepines declined only modestly from 6.9% to 6.5%, associated with pain management clinic laws but not other policies examined.
The opioid policy environment has changed rapidly with a range of different policies being implemented addressing high-risk prescribing. PDMP laws mandating prescriber use and pain clinic laws both appear efficacious but decrease different types of high-risk opioid prescribing. New policies should be considered in light of the prevalence of the problem being addressed.
为了减少高危阿片类药物处方，已经实施了多项州政策，如处方药物监测计划（PDMP）和持续时间限制。研究表明，许多政策减少了某些阿片类药物的处方行为，但很少有研究考察它们对目标高危处方实践的预期效果，也没有理清可能影响这些实践的同时实施的州或联邦政策的影响。
使用全国药房索赔数据，确定了 2007 年至 2018 年 4100 万例新阿片类药物发作的初始处方。我们确定了高危初始处方，定义为 >7 天供应量、平均每日 MME >90 或与苯二氮䓬类药物同时使用，并估计了三个多变量逻辑回归模型，以控制患者、处方者和县特征，评估政策与结果之间的关联。
7 天的初始处方从 2007 年的 23.8%下降到 2018 年的 14.9%，这与强制性和互操作性 PDMP 和处方持续时间限制有关，但与其他研究的政策无关。每日 MME >90 的初始处方从 13.2%下降到 1.9%，与疼痛管理诊所法律有关，但与其他政策不一致。与苯二氮䓬类药物同时使用的初始处方仅略有下降，从 6.9%下降到 6.5%，与疼痛管理诊所法律有关，但与其他研究的政策无关。
阿片类药物政策环境发生了快速变化，实施了一系列不同的政策来解决高危处方问题。要求医生使用 PDMP 的法律和疼痛诊所法律似乎都有效，但减少了不同类型的高危阿片类药物处方。应该根据所解决问题的普遍性考虑新政策。
