系统识别和分类 16 个州和华盛顿特区的阿片类药物处方和配药政策。
Systematic Identification and Categorization of Opioid Prescribing and Dispensing Policies in 16 States and Washington, DC.
机构信息
School of Global Health Management & Informatics, University of Central Florida, Orlando, Florida.
Department of Internal Medicine (Secondary Joint Appointment), University of Central Florida, Orlando, Florida.
出版信息
Pain Med. 2023 Feb 1;24(2):130-138. doi: 10.1093/pm/pnac124.
OBJECTIVES
State policies can impact opioid prescribing or dispensing. Some state opioid policies have been widely examined in empirical studies, including prescription drug monitoring programs and pain clinic licensure requirements. Other relevant policies might exist that have received limited attention. Our objective was to identify and categorize a wide range of state policies that could affect opioid prescribing/dispensing.
METHODS
We used stratified random sampling to select 16 states and Washington, DC, for our sample. We collected state regulations and statutes effective during 2020 from each jurisdiction, using search terms related to opioids, pain management, and prescribing/dispensing. We then conducted qualitative template analysis of the data to identify and categorize policy categories.
RESULTS
We identified three dimensions of opioid prescribing/dispensing laws: the prescribing/dispensing rule, its applicability, and its disciplinary consequences. Policy categories of prescribing/dispensing rules included clinic licensure, staff credentials, evaluating the appropriateness of opioids, limiting the initiation of opioids, preventing the diversion or misuse of opioids, and enhancing patient safety. Policy categories related to applicability of the law included the pain type, substance type, practitioner, setting, payer, and prescribing situation. The disciplinary consequences dimension included specific consequences and inspection processes.
DISCUSSION
Policy categories within each dimension of opioid prescribing/dispensing laws could become a foundation for creating variables to support empirical analyses of policy effects, improving operationalization of policies in empirical studies, and helping to disentangle the effects of multiple state laws enacted at similar times to address the opioid crisis. Several of the policy categories we identified have been underexplored in previous empirical studies.
目的
国家政策会影响阿片类药物的处方或配药。一些国家的阿片类药物政策已经在实证研究中得到了广泛的研究，包括处方药物监测计划和疼痛诊所许可要求。其他相关政策可能存在，但受到的关注有限。我们的目的是确定和分类广泛的可能影响阿片类药物处方/配药的国家政策。
方法
我们使用分层随机抽样选择了 16 个州和华盛顿特区作为我们的样本。我们使用与阿片类药物、疼痛管理和处方/配药相关的搜索词，从每个司法管辖区收集 2020 年有效的州法规和法规。然后，我们对数据进行定性模板分析，以确定和分类政策类别。
结果
我们确定了阿片类药物处方/配药法律的三个维度：处方/配药规则、其适用性及其纪律后果。处方/配药规则的政策类别包括诊所许可、员工资质、评估阿片类药物的适宜性、限制阿片类药物的初始使用、防止阿片类药物的转移或滥用，以及增强患者安全。与法律适用性相关的政策类别包括疼痛类型、物质类型、从业者、场所、支付者和处方情况。纪律后果维度包括具体的后果和检查程序。
讨论
阿片类药物处方/配药法律的每个维度中的政策类别可以成为创建变量的基础，以支持对政策效果的实证分析，改进实证研究中政策的操作性，以及帮助理清在解决阿片类药物危机时同时颁布的多项州法律的影响。我们确定的一些政策类别在以前的实证研究中研究不足。
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