Underwood NL, Kane H, Cance J, Emery K, Elek E, Zule W, Rooks-Peck C, Sargent W, Mells J. Achieving Reductions in Opioid Dispensing: A Qualitative Comparative Analysis of State-Level Efforts to Improve Prescribing.
J Public Health Manag Pract 2023;
29:262-270. [PMID:
36112160 PMCID:
PMC9892169 DOI:
10.1097/phh.0000000000001583]
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Abstract
OBJECTIVE
To determine whether any combinations of state-level public health activities were necessary or sufficient to reduce prescription opioid dispensing.
DESIGN
We examined 2016-2019 annual progress reports, 2014-2019 national opioid dispensing data (IQVIA), and interview data from states to categorize activities. We used crisp-set Qualitative Comparative Analysis to determine which program activities, individually or in combination, were necessary or sufficient for a better than average decrease in morphine milligram equivalent (MME) per capita.
SETTING
Twenty-nine US state health departments.
PARTICIPANTS
State health departments implementing the Centers for Disease Control and Prevention's Prevention for States (PfS) program.
MAIN OUTCOME
Combinations of prevention activities related to changes in the rate of prescription opioid MME per capita dispensing from 2014 to 2019.
RESULTS
Three combinations were sufficient for greater than average state-level reductions in MME per capita: (1) expanding and improving proactive reporting in combination with enhancing the uptake of evidence-based opioid prescribing guidelines and not moving toward a real-time Prescription Drug Monitoring Program; (2) implementing or improving prescribing interventions for insurers, health systems, or pharmacy benefit managers in combination with enhancing the uptake of evidence-based opioid prescribing guidelines; and (3) not implementing or improving prescribing interventions for insurers, health systems, or pharmacy benefit managers in combination with not enhancing the uptake of evidence-based opioid prescribing guidelines. Interview data suggested that the 3 combinations indicate how state contexts and history with addressing opioid overdose shaped programming and the ability to reduce MME per capita.
CONCLUSIONS
States successful in reducing opioid dispensing selected activities that built upon existing policies and interventions, which may indicate thoughtful use of resources. To maximize impact in addressing the opioid overdose epidemic, states and agencies may benefit from building on existing policies and interventions.
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