阿片类药物处方限制法对慢性疼痛患者阿片类药物和其他疼痛治疗的影响。
Effects of Opioid Prescribing Cap Laws on Opioid and Other Pain Treatments Among Persons with Chronic Pain.
机构信息
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
出版信息
J Gen Intern Med. 2023 Mar;38(4):929-937. doi: 10.1007/s11606-022-07796-8. Epub 2022 Sep 22.
BACKGROUND
Many states have adopted laws that limit the amount or duration of opioid prescriptions. These limits often focus on prescriptions for acute pain, but there may be unintended consequences for those diagnosed with chronic pain, including reduced opioid prescribing without substitution of appropriate non-opioid treatments.
OBJECTIVE
To evaluate the effects of state opioid prescribing cap laws on opioid and non-opioid treatment among those diagnosed with chronic pain.
DESIGN
We used a difference-in-differences approach that accounts for staggered policy adoption. Treated states included 32 states that implemented a prescribing cap law between 2017 and 2019.
POPULATION
A total of 480,856 adults in the USA who were continuously enrolled in medical and pharmacy coverage from 2013 to 2019 and diagnosed with a chronic pain condition between 2013 and 2016.
MAIN MEASURES
Among individuals with chronic pain in each state: proportion with at least one opioid prescription and with prescriptions of a specific duration or dose, average number of opioid prescriptions, average opioid prescription duration and dose, proportion with at least one non-opioid chronic pain prescription, average number of such prescriptions, proportion with at least one chronic pain procedure, and average number of such procedures.
KEY RESULTS
State laws limiting opioid prescriptions were not associated with changes in opioid prescribing, non-opioid medication prescribing, or non-opioid chronic pain procedures among patients with chronic pain diagnoses.
CONCLUSIONS
These findings do not support an association between state opioid prescribing cap laws and changes in the treatment of chronic non-cancer pain.
背景
许多州都通过了限制阿片类药物处方数量或时长的法律。这些限制通常针对急性疼痛的处方，但对于那些被诊断为慢性疼痛的患者可能会产生意想不到的后果，包括减少阿片类药物处方而没有适当的非阿片类药物替代治疗。
目的
评估州阿片类药物处方上限法对诊断为慢性疼痛的患者的阿片类药物和非阿片类药物治疗的影响。
设计
我们使用了一种差异中的差异方法，该方法考虑了政策的交错采用。治疗州包括 2017 年至 2019 年间实施处方上限法的 32 个州。
人群
美国共有 480856 名成年人在 2013 年至 2019 年期间连续参加了医疗和药房保险，并在 2013 年至 2016 年期间被诊断为慢性疼痛。
主要措施
在每个州的慢性疼痛患者中：至少有一张阿片类药物处方和特定剂量或持续时间处方的比例、平均阿片类药物处方数量、平均阿片类药物处方持续时间和剂量、至少有一张非阿片类慢性疼痛处方的比例、此类处方的平均数量、至少有一张慢性疼痛程序的比例和此类程序的平均数量。
主要结果
限制阿片类药物处方的州法律与慢性疼痛诊断患者的阿片类药物处方、非阿片类药物处方或非阿片类慢性疼痛程序的变化无关。
结论
这些发现不支持州阿片类药物处方上限法与慢性非癌症疼痛治疗变化之间的关联。
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