Methodological challenges and proposed solutions for evaluating opioid policy effectiveness
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Methodological challenges and proposed solutions for evaluating opioid policy effectiveness Megan S. Schuler1 · Beth Ann Griffin2 · Magdalena Cerdá3 · Emma E. McGinty4 · Elizabeth A. Stuart5 Received: 30 April 2020 / Revised: 3 October 2020 / Accepted: 27 October 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Opioid-related mortality increased by nearly 400% between 2000 and 2018. In response, federal, state, and local governments have enacted a heterogeneous collection of opioidrelated policies in an effort to reverse the opioid crisis, producing a policy landscape that is both complex and dynamic. Correspondingly, there has been a rise in opioid-policy related evaluation studies, as policymakers and other stakeholders seek to understand which policies are most effective. In this paper, we provide an overview of methodological challenges facing opioid policy researchers when conducting opioid policy evaluation studies using observational data, as well as some potential solutions to those challenges. In particular, we discuss the following key challenges: (1) Obtaining high-quality opioid policy data; (2) Appropriately operationalizing and specifying opioid policies; (3) Obtaining high-quality opioid outcome data; (4) Addressing confounding due to systematic differences between policy and non-policy states; (5) Identifying heterogeneous policy effects across states, population subgroups, and time; (6) Disentangling effects of concurrent policies; and (7) Overcoming limited statistical power to detect policy effects afforded by commonly-used methods. We discuss each of these challenges and propose some ways forward to address them. Increasing the methodological rigor of opioid evaluation studies is imperative to identifying and implementing opioid policies that are most effective at reducing opioidrelated harms. Keywords Opioid policy · Statistical methodology · Data quality · Treatment heterogeneity · Selection bias
* Megan S. Schuler [email protected] 1
RAND Corporation, 20 Park Plaza #920, Boston, MA 02216, USA
2
RAND Corporation, 1200 S Hayes Street, Arlington, VA 22202, USA
3
Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue 4‑16, New York, NY 10016, USA
4
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
5
Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
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Vol.:(0123456789)
Health Services and Outcomes Research Methodology
1 Introduction The use of opioids has skyrocketed over the last decade in the United States, with serious health and social consequences. In 2018, nearly 10 million people misused prescription opioids, approximately 800,000 used heroin, and 2 million people had an opioid use disorder (OUD) (SAMHSA 2019). Opioid-related mortality increased by nearly 400% between 2000 and 2018 (Hedegaard et al. 2020). In response, federal, state, and local gover
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