州级阿片类药物处方限额法对术后阿片类药物处方的影响。
Effects of state opioid prescribing cap laws on opioid prescribing after surgery.
机构信息
Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
出版信息
Health Serv Res. 2022 Oct;57(5):1154-1164. doi: 10.1111/1475-6773.14023. Epub 2022 Jul 29.
OBJECTIVE
To evaluate the effects of state opioid prescribing cap laws on opioid prescribing after surgery.
DATA SOURCES
OptumLabs Data Warehouse administrative claims data covering all 50 states from July 2012 through June 2019.
STUDY DESIGN
We included individuals from 20 states that had implemented prescribing cap laws without exemptions for postsurgical pain by June 2019 and individuals from 16 control states plus the District of Columbia. We used a difference-in-differences approach accounting for differential timing in law implementation across states to estimate the effects of state prescribing cap laws on postsurgical prescribing of opioids. Outcome measures included filling an opioid prescription within 30 days after surgery; filling opioid prescriptions of specific doses or durations; and the number, days' supply, daily dose, and pill quantity of opioid prescriptions. To assess the validity of the parallel counterfactual trends assumption, we examined differences in outcome trends between law-implementing and control states in the years preceding law implementation using an equivalence testing framework.
DATA COLLECTION/EXTRACTION METHODS: We included the first surgery in the study period for opioid-naïve individuals undergoing one of eight common surgical procedures.
PRINCIPAL FINDINGS
State prescribing cap laws were associated with 0.109 lower days' supply of postsurgical opioids on the log scale (95% Confidence Interval [CI]: -0.139, -0.080) but were not associated with the number (Average treatment effect on the treated [ATT]: -0.011; 95% CI: -0.043, 0.021) or daily dose of postsurgical opioid prescriptions (ATT: -0.013; 95% CI: -0.030, 0.005). The negative association observed between prescribing cap laws and the probability of filling a postsurgical opioid prescription (ATT: -0.041; 95% CI: -0.054, -0.028) was likely spurious, given differences between law-implementing and control states in the pre-law period.
CONCLUSIONS
Prescribing cap laws appear to have minimal effects on postsurgical opioid prescribing.
目的
评估州级阿片类药物处方配给上限法对术后阿片类药物处方的影响。
数据来源
OptumLabs 数据仓库的行政索赔数据，涵盖 2012 年 7 月至 2019 年 6 月的所有 50 个州。
研究设计
我们纳入了 20 个州的个体，这些州在 2019 年 6 月之前已经实施了没有术后疼痛豁免的配给上限法，以及 16 个对照州和哥伦比亚特区的个体。我们使用差异中的差异方法，考虑到各州实施法律的时间差异，来估计州级处方配给上限法对术后阿片类药物处方的影响。结果测量包括术后 30 天内开阿片类药物处方；开特定剂量或持续时间的阿片类药物处方；以及阿片类药物处方的数量、天供应量、日剂量和药丸数量。为了评估平行反事实趋势假设的有效性，我们使用等效性检验框架，在法律实施前的几年里，检查了实施法律和对照州之间的结果趋势差异。
数据收集/提取方法：我们纳入了研究期间接受八项常见手术之一的阿片类药物初治个体的第一次手术。
主要发现
州级处方配给上限法与术后阿片类药物天供应量减少 0.109 个对数标度（95%置信区间 [CI]：-0.139，-0.080）相关，但与术后阿片类药物处方数量（治疗组平均治疗效果 [ATT]：-0.011；95% CI：-0.043，0.021）或日剂量（ATT：-0.013；95% CI：-0.030，0.005）无关。观察到的配给上限法与术后阿片类药物处方填充概率之间的负相关（ATT：-0.041；95% CI：-0.054，-0.028）可能是虚假的，因为在法律实施前，实施州和对照州之间存在差异。
结论
处方配给上限法似乎对术后阿片类药物处方的影响很小。
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