Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Seattle, WA, 98101, United States; New York University, Grossman School of Medicine, Center for Opioid Epidemiology and Policy, 180 Madison Ave, 4th Floor, New York City, NY, 10016, United States.
New York University, Grossman School of Medicine, Center for Opioid Epidemiology and Policy, 180 Madison Ave, 4th Floor, New York City, NY, 10016, United States.
Int J Drug Policy. 2022 Oct;108:103809. doi: 10.1016/j.drugpo.2022.103809. Epub 2022 Jul 28.
States have enacted multiple types of laws, with a variety of constituent provisions, in response to the opioid epidemic, often simultaneously. This temporal proximity and variation in state-to-state operationalization has resulted in significant challenges for empirical research on their effects. Thus, expert consensus can be helpful to classify laws and their provisions by their degree of helpfulness and impact.
We conducted a four-stage modified policy Delphi process to identify the top 10 most helpful and 5 most harmful provisions from eight opioid-related laws. This iterative consultation with six types of opioid experts included a preliminary focus group (n=12), two consecutive surveys (n=56 and n=40, respectively), and a final focus group feedback session (n=5).
On a scale of very harmful (0) to very helpful (4), overdose Good Samaritan laws received the highest average helpfulness rating (3.62, 95% CI: 3.48-3.75), followed by naloxone access laws (3.37, 95% CI: 3.22-3.51), and pain management clinic laws (3.08, 95% CI: 2.89-3.26). Drug-induced homicide (DIH) laws were rated the most harmful (0.88, 95% CI: 0.66-1.11). Impact ratings aligned similarly, although Medicaid laws received the second highest overall impact rating (3.71, 95% CI: 3.45, 3.97). The two most helpful provisions were naloxone standing orders (3.94, 95% CI: 3.86-4.02) and Medicaid coverage of medications for opioid use disorder (MOUD) (3.89, 95% CI: 3.82). Mandatory minimum DIH laws were the most harmful provision (0.73, 95% CI 0.53-0.93); followed by requiring prior authorization for Medicaid coverage of MOUD (1.00 95% CI: 0.72-1.27).
Overall, experts rated laws and provisions that facilitated harm reduction efforts and access to MOUD as most helpful. Laws and provisions rated as most harmful criminalized substance use and placed restrictions on access to MOUD. These ratings provide a foundation for evaluating the overall overdose policy environment for each state.
为应对阿片类药物泛滥问题，各州颁布了多种类型的法律，其中包含各种构成条款，且往往同时颁布。这种在时间上的临近以及各州实施方式的差异，给这些法律效果的实证研究带来了重大挑战。因此，专家共识可以帮助根据其有益程度和影响对法律及其条款进行分类。
我们进行了四阶段的改良政策 Delphi 流程，从八项阿片类相关法律中确定了最有帮助的前 10 项和最有害的 5 项条款。这项咨询涉及六种类型的阿片类专家，包括一个初步的焦点小组（n=12）、两次连续的调查（n=56 和 n=40），以及最后一次焦点小组反馈会议（n=5）。
在非常有害（0）到非常有帮助（4）的评分尺度上，过量用药急救者法案获得了最高的平均有益性评分（3.62，95%置信区间：3.48-3.75），其次是纳洛酮获取法（3.37，95%置信区间：3.22-3.51）和疼痛管理诊所法（3.08，95%置信区间：2.89-3.26）。药物诱发杀人罪（DIH）法被评为最有害（0.88，95%置信区间：0.66-1.11）。影响评分也相似，尽管医疗补助法获得了第二高的总体影响评分（3.71，95%置信区间：3.45，3.97）。最有帮助的两项条款是纳洛酮待命令（3.94，95%置信区间：3.86-4.02）和医疗补助对阿片类药物使用障碍治疗药物的覆盖（3.89，95%置信区间：3.82）。强制性最低 DIH 法是最有害的条款（0.73，95%置信区间 0.53-0.93）；其次是要求医疗补助对阿片类药物使用障碍治疗药物的覆盖进行事先授权（1.00 95% CI：0.72-1.27）。
总的来说，专家们认为那些有助于减少伤害和获得阿片类药物使用障碍治疗药物的法律和条款最有帮助。被评为最有害的法律和条款将药物使用定为犯罪，并对获得阿片类药物使用障碍治疗药物的途径施加限制。这些评分结果为评估每个州的整体过量用药政策环境提供了基础。
