Opioid supply control policies may have unintended effects, a study finds

In response to the increase in opioid overdose deaths in the United States, many states have implemented supply control and harm reduction measures aimed at reducing these deaths. But a recent study from Indiana University found that the policies may have had an unintended consequence of encouraging those with opioid use disorders to switch to other illegal substances, leading to more fatalities. height with too much.

“Literature from public health to social sciences has yielded mixed and contradictory findings on the impact of opioid policies on several opioid side effects,” said Byungkyu Lee, associate professor of sociology at IU and co-author of the study. “Our findings suggest that the so-called opioid paradox – an increase in opioid-related deaths despite a decrease in opioid prescriptions – could arise from the success, not failure, of state interventions to control keep on opioid prescriptions. “

Researchers used the National Vital Statistics System and Optum Clinformatics DataMart to look at drug overdose mortality data from 50 states and claims data from 23 million commercially insured patients in the U.S. between 2007 and 2018. They then assessed frequency. symptoms of pharmacological opioid abuse, opioid use disorder and overdose diagnosis, and prescribing medication-assisted treatment and pre-drug death before and after the implementation of six state-level policies aimed at the disease epidemic opioid.

Policies included prescription drug check program access, mandatory prescription drug check programs, pain clinic laws, drug end laws, naloxone access laws and Good Samaritan laws.

The study, published in the Open JAMA Network, found that supply control policies were associated with a lower proportion of patients taking opioids, having overdose claims, receiving higher opioid doses and visiting several suppliers and shops. They also found that harm reduction policies were associated with small increases in the proportion of patients with hypertension and opioid use disorder. In addition, the proportion of patients receiving medication-assisted treatment drugs increased following the implementation of supply-control policies.

Brea Perry, professor of sociology at IU and co-author of the study, said these findings demonstrate the power of big data to provide insights into opioid addiction and how best to reverse it.

“Our work highlights the unexpected and negative effects of policies designed to reduce the supply of opioids in the population for too much,” Perry said. “We believe that policy objectives should move from easy solutions such as dose reduction to more difficult basic ones, focusing on improving social conditions that create demand for opioids and other illegal drugs. “

In terms of pre-existing deaths, the study found that all pre-existing deaths increased after naloxone access laws were enforced, particularly deaths due to heroin, synthetic opioids and cocaine. Good Samaritan laws were also associated with an increase in excessive deaths.

In addition, prescription drug monitoring programs were associated with a reduction in overdose deaths from natural opioids and methadone, and implementation of pain clinical laws was associated with an increase in the number of heroin and cocaine overdose deaths. However, obtaining a drug termination law was associated with a reduction in excessive deaths from synthetic opioids.

“Our work shows that there is no easy policy solution to prevent opioid addiction and mortality in the U.S.,” Lee said. “To address the opioid paradox, it is essential to design policies to address the underlying causes of premature death, such as lack of economic opportunity, chronic physical and mental pain, and increased treatment for drug dependence and hypertension rather than targeting opioid analgesic agents as a cause of harm. “