论文标题

优化收益和安全处置处方阿片类药物,以减少向二级用户和黑市的转移

Optimizing Return and Secure Disposal of Prescription Opioids to Reduce the Diversion to Secondary Users and Black Market

论文作者

Hasan, Md Mahmudul, Faiz, Tasnim Ibn, Modestino, Alicia Sasser, Young, Gary J., Noor-E-Alam, Md.

论文摘要

在美国,阿片类药物使用障碍(OUD)已达到流行病。将未使用的处方阿片类药物转移给二级用户和黑市大大导致滥用和滥用这些高度上瘾的药物,从而导致社区内OUD和意外阿片类药物过量的风险增加。因此,设计有效的策略以减少可能通过患者水平的转移发生的阿片类药物的非医学使用。在本文中,我们旨在通过设计返回和安全处理未使用的处方阿片类药物的策略来解决这个关键的公共卫生问题。我们提出了一个数据驱动的优化框架,以确定易于使用的阿片类药物处置亭的最佳激励支出计划和位置,以激发各种配置文件的处方阿片用户,以返回其未使用的阿片类药物。我们开发了一个混合成员非线性编程(MINLP)模型来解决决策问题,然后使用Benders分解进行重新制定方案,从而导致计算有效的解决方案。我们提出了一个案例研究,以使用马萨诸塞州所有付款人索赔数据(MA APCD)创建的数据集来显示模型的好处和可用性。我们提出的模型允许政策制定者估算并包括与处方阿片类药物转移相关的经济和医疗保健负担,包括罚款费用。我们的数值实验证明了模型和实用性在确定阿片类药物处置亭的最佳位置以及最大化未使用阿片类药物处置的激励支出计划方面的能力。拟议的优化框架提供了各种权衡策略,可以帮助政府机构设计实用政策,以减少未使用的处方阿片类药物的转移。

Opioid Use Disorder (OUD) has reached an epidemic level in the US. Diversion of unused prescription opioids to secondary users and black market significantly contributes to the abuse and misuse of these highly addictive drugs, leading to the increased risk of OUD and accidental opioid overdose within communities. Hence, it is critical to design effective strategies to reduce the non-medical use of opioids that can occur via diversion at the patient level. In this paper, we aim to address this critical public health problem by designing strategies for the return and safe disposal of unused prescription opioids. We propose a data-driven optimization framework to determine the optimal incentive disbursement plans and locations of easily accessible opioid disposal kiosks to motivate prescription opioid users of diverse profiles in returning their unused opioids. We develop a Mixed-Integer Non-Linear Programming (MINLP) model to solve the decision problem, followed by a reformulation scheme using Benders Decomposition that results in a computationally efficient solution. We present a case study to show the benefits and usability of the model using a dataset created from Massachusetts All Payer Claims Data (MA APCD). Our proposed model allows the policymakers to estimate and include a penalty cost considering the economic and healthcare burden associated with prescription opioid diversion. Our numerical experiments demonstrate the ability of model and usefulness in determining optimal locations of opioid disposal kiosks and incentive disbursement plans for maximizing the disposal of unused opioids. The proposed optimization framework offers various trade-off strategies that can help government agencies design pragmatic policies for reducing the diversion of unused prescription opioids.

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