Unintentional overdose deaths increased 173% among adults between 1999 and 2010 in the U.S. This increase has mostly been attributed to prescription opioid overdoses, and prevention of prescription drug overdoses represents a key priority area of the CDC’s National Center for Injury Prevention and Control. Opioids have been increasingly used in pain treatment in the U.S., particularly for chronic non-cancer pain, and the parallel increases in opioid-related overdoses and opioid prescribing has led many to suggest that prescribing practices are related to opioid overdose. A primary effort to address the problem has been through state legislation and policy related to opioid prescribing or legal protections for individuals responding to an overdose. Studies have examined the impact of prescription drug monitoring programs on population overdose rates, with mixed findings. To date, there has been no comprehensive evaluation of the impact of relevant laws. The objective of this study will be to examine the impact of enactment of seven specific types of state laws on overdose rates.
Methods: There are three primary sources of data for this study. They are: (1) information of state laws obtained through the CDC1, state legislative records, and other sources, and (2) drug-specific, state-level overdose rates obtained from the WONDER database, and (3) mortality and health system data obtained for Veterans Health Administration (VHA) patients nationally (to explore differential impact among those with known medical access to opioids). Additionally, census and NCHS data will be used to create control variables. State laws will be coded on a yearly basis to reflect time of enactment (available in CDC documentation). Bayesian spatio-temporal models will be used to account for correlations of time and geographical proximity.