High levels of opioid analgesic co-prescription among methadone maintenance treatment clients in British Columbia, Canada: results from a population-level retrospective cohort study.
High levels of opioid analgesic co-prescription among methadone maintenance treatment clients in British Columbia, Canada: results from a population-level retrospective cohort study.
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加拿大不列颠哥伦比亚省美沙酮维持治疗客户中阿片类镇痛联合处方的高水平：人口水平回顾性队列研究的结果。
DOI：
10.1111/j.1521-0391.2014.12091.x
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发表时间：
2014
期刊：
影响因子：
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通讯作者：
Anis,AslamH
中科院分区：
文献类型：
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作者：
Nosyk,Bohdan;Fischer,Benedikt;Sun,Huiying;Marsh,DavidC;Kerr,Thomas;Rehm,JuergenT;Anis,AslamH
在北美，处方阿片类药物（PO）的非医疗使用急剧增加。对于接受美沙酮维持治疗的个人，需要特别考虑PO处方。我们的目的是描述1996年至2007年不列颠哥伦比亚省（BC）MMT客户中PO使用的患病率和相关性。所有因阿片类药物依赖而接受30天连续MMT的个人都被纳入该研究。主要测量包括1996年至2007年MMT期间接受美沙酮以外PO>7天的客户比例。采用广义线性混合效应回归对MMT期间与PO联合处方独立相关的因素进行评估。结果在研究期间确定了16，248例患者，其中27，919例MMT发作持续时间至少30天。其中，5，552人（34.2%）在MMT期间共接受了290，543次PO联合处方。所有PO分发>7天的大多数（74.3%）来自非MMT医生。在1996年至2006年期间，由于吗啡、氢吗啡酮和羟考酮处方量的增加，人均PO处方量几乎翻了一番。PO共同处方与女性性别，年龄较大，较高水平的医疗并发症以及较高的MMT剂量，依从性和retention.Conclusion and Scientific SignificanceA大比例的MMT客户在BC收到共同发生PO处方，往往从医生和药房不提供MMT。需要MMT患者疼痛治疗的实验证据来指导临床实践。(Am J Addict 2014;23：257-264）
Background and ObjectivesThe non‐medical use of prescription opioids (PO) has increased dramatically in North America. Special consideration for PO prescription is required for individuals in methadone maintenance treatment (MMT). Our objective is to describe the prevalence and correlates of PO use among British Columbia (BC) MMT clients from 1996 to 2007.MethodsThis study was based on a linked, population‐level medication dispensation database. All individuals receiving 30 days of continuous MMT for opioid dependence were included in the study. Key measurements included the proportion of clients receiving >7 days of a PO other than methadone during MMT from 1996 to 2007. Factors independently associated with PO co‐prescription during MMT were assessed using generalized linear mixed effects regression.Results16,248 individuals with 27,919 MMT episodes at least 30 days in duration were identified for the study period. Among them, 5,552 individuals (34.2%) received a total of 290,543 PO co‐prescriptions during MMT. The majority (74.3%) of all PO dispensations >7 days originated from non‐MMT physicians. The number of PO prescriptions per person‐year nearly doubled between 1996 and 2006, driven by increases in morphine, hydromorphone and oxycodone dispensations. PO co‐prescription was positively associated with female gender, older age, higher levels of medical co‐morbidity as well as higher MMT dosage, adherence, and retention.Conclusion and Scientific SignificanceA large proportion of MMT clients in BC received co‐occurring PO prescriptions, often from physicians and pharmacies not delivering MMT. Experimental evidence for the treatment of pain in MMT clients is required to guide clinical practice. (Am J Addict 2014;23:257–264)