Pilot programs have been implemented in cities across the U.S. to address the first- and last- mile problem with door-to-door shared microtransit, ridehailing companies, and shared-ride operators with dynamic pick-up locations. The City of Rancho Cordova and Lyft partnered to launch one such pilot in the form of a discount-based door-to-door (D2D) coupon program named “Free ＄5 to Ride”. The program offers ＄5 credits to Lyft riders who start or end their trips at one of four Sacramento Regional Transit District (SacRT) light rail stations. The program was designed to reduce rider dependence on personal vehicles and increase the overall convenience of transit use in the region. UC Davis researchers conducted an evaluation of the “Free ＄5 to Ride” program during its operational period of May 2019 through June 2021. Researchers developed a participant survey and used survey data along with participant trip data, ridership data for the SacRT light rail, and ridership data for the Rancho CordoVan shuttle service to characterize the outcomes of the pilot program. The evaluation shows that the coupon program was generally well-received. Participation levels increased dramatically by early 2020, and while trip activity dropped at the onset of the COVID-19 pandemic, program activity remained fairly constant through the end of the program. Researchers encountered survey sampling limitations due to ridehailing customer engagement policies, suggesting that future evaluations of similar programs would benefit from increased data access, or modified policies allowing operators to conduct more extensive outreach in support of these studies.

Context

On October 6, 2014, the United States Drug Enforcement Administration (DEA) implemented a regulatory change for hydrocodone combination products (HCPs), moving them from Schedule III to II, in an effort to decrease drug overdoses. Existing research suggests this regulatory action reduced HCP prescribing and dispensing; however, there is limited research assessing its possible effects on overdoses and accidental exposures.

Objective

To analyze the changes in opioid exposures reported to the California Poison Control System (CPCS) before and after DEA rescheduling of HCPs.

Methods

We collected monthly exposure data reported to CPCS from 2012 to 2019 and conducted interrupted time series analyses to assess changes in exposures after rescheduling for HCPs, tramadol, oxycodone, morphine, codeine, fentanyl, and heroin. Additional analyses were done to assess any changes in exposures resulting in severe outcomes (moderate or major health effects). For HCPs, we also conducted logistic regressions to identify characteristics of exposures resulting in severe outcomes before and after rescheduling.

Results

Overall monthly opioid exposures reported to CPCS decreased after DEA rescheduling of HCPs. These decreases were significant for HCP, tramadol, and morphine (p < 0.001). Exposures significantly increased for heroin and fentanyl (p < 0.001). There were no significant changes in the share of severe outcomes attributed to HCP exposures after rescheduling.

Discussion

The DEA rescheduling of HCPs was associated with a significant decrease in HCP exposures and prescription opioid exposures overall, but was associated with increased fentanyl and heroin exposures. While other initiatives may have contributed to this decrease, our findings suggest that rescheduling may be a useful regulatory strategy to reduce drug exposures.

Conclusion

DEA rescheduling of HCPs was associated with a significant reduction in prescription opioid exposures, suggesting that rescheduling high-risk drugs may be an effective strategy to improve public health.