Trends in use and misuse of opioids in the Netherlands: a retrospective, multi-source database study
Trends in use and misuse of opioids in the Netherlands: a retrospective, multi-source database study
复制标题
DOI：
10.1016/s2468-2667(19)30128-8
复制
发表时间：
2019-10-01
影响因子：
50
通讯作者：
Schellekens, Arnt
中科院分区：
文献类型：
--
作者：
Kalkman, Gerard Arnoldus;Kramers, Cornelis;Schellekens, Arnt
美国目前正面临着严重的阿片类药物滥用流行病，开始时羟考酮处方增加，并将疼痛列为第五个生命体征，最终导致大量过量死亡。在欧洲，包括荷兰，类阿片的医疗用途（主要是羟考酮）自2009年以来也有所增加，但阿片类药物滥用代理的增加尚未被描述。方法对于这项回顾性的多源数据库研究，要求荷兰几个国家数据库提供数据，以评估以下时间趋势：（1）使用阿片类药物处方的人数，（2）与阿片类药物中毒有关的住院人数，（3）因阿片类药物使用障碍而接受治疗的人数，以及（4）死于阿片类药物中毒的人数。数据采用荷兰统计局2008- 2017年的人口数据，以每100 000名居民的人数表示。有关服用阿片类药物处方人数的数据来自荷兰国家医疗保健研究所（Zorginstituut Nederland）托管的药物信息项目（Genees- en hulpiniddelen Infonnatie Project）数据库。关于2008年至2017年期间阿片类药物相关住院的数据来自荷兰国家医院护理基本注册（Landelijke Basisregistratie Ziekenhuiszorg），该数据库由荷兰医院数据管理。有关成瘾治疗的数据来自国家酒精和药物信息系统（Landelijk Alcohol en Drugs Informatie Systemem）。2008年至2017年阿片类药物死亡率数据来自荷兰统计局主办的死因统计数据库。结果在2008年至2017年期间，处方阿片类药物使用者的总数几乎翻了一番，从每10万居民4109人增加到每10万居民7489人，主要是因为羟考酮使用者的数量翻了两番，从每10万居民574人增加到2568人。在同一时期，阿片类药物相关的住院人数增加了两倍，从每10万居民2.5人增加到7.8人，2008年至2015年期间，因海洛因以外的阿片类药物使用障碍而接受成瘾治疗的患者人数从每10万居民3.1人增加到5.6人。阿片类药物相关死亡率在2008年至2014年期间保持稳定，每10万居民中有0.21人死亡，但在2014年之后，2017年每10万居民中有0.65人死亡。虽然荷兰远离美国面临的阿片类药物流行病，但应实施安全的阿片类药物处方指南，以防止进一步升级，并为有需要的人提供阿片类止痛药。版权所有（C）2019 The Au thor（s）.爱思唯尔有限公司出版
Background The USA is currently facing a serious opioid misuse epidemic that started with increased prescribing of oxycodone and the inclusion of pain as a fifth vital sign, and eventually resulted in massive overdose mortality. In Europe, including the Netherlands, the medical use of opioids (mainly oxycodone) has also increased since 2009, but an increase in proxies for opioid misuse has not yet been described.Methods For this retrospective, multi-source database study, data were requested from several national databases in the Netherlands to evaluate the following time trends: (1) number of people with opioid prescriptions, (2) number of hospital admissions related to opioid intoxication, (3) number of people treated for opioid use disorder, and (4) number of people who died from opioid poisoning. Data were presented as the number per 100 000 inhabitants, using population data over the years 2008-17 from Statistics Netherlands (Centraal Bureau voor de Statistiek). Data about the number of people with opioid prescriptions was obtained from the Drug Information Project (Genees- en hulpiniddelen Infonnatie Project) database hosted by the Dutch National Health Care Institute (Zorginstituut Nederland). Data about opioid-related hospital admissions between 2008 and 2017 were obtained from the Dutch National Hospital Care Basic Registration (Landelijke Basisregistratie Ziekenhuiszorg), a database managed by Dutch Hospital Data. Data about addiction treatment were obtained from the National Alcohol and Drugs Information System (Landelijk Alcohol en Drugs Informatie Systeem). Data on opioid mortality between 2008 and 2017 were obtained from the cause-of-death statistics database hosted by Statistics Netherlands. Each database covered almost the entire population of the Netherlands.Findings Between 2008 and 2017, the overall number of prescription opioid users nearly doubled from 4109 per 100 000 inhabitants to 7489 per 100 000 inhabitants, mainly because the number of oxycodone users quadrupled from 574 to 2568 per 100 000 inhabitants. In the same period, the number of opioid-related hospital admissions tripled from 2.5 to 7.8 per 100 000 inhabitants, and between 2008 and 2015 the number of patients in addiction care for opioid use disorders other than heroin increased from 3.1 to 5.6 per 100 000 inhabitants. Opioid-related mortality was stable between 2008 and 2014 with 0.21 deaths per 100 000 inhabitants, but after 2014 it increased to 0.65 per 100 000 inhabitants in 2017.Interpretation Prescription opioid use increased substantially between 2008 and 2017, and several proxies for misuse show a parallel increasing trend. Although the Netherlands is far from the opioid epidemic faced by the USA, safe opioid prescribing guidelines should be implemented to prevent further escalation and to keep opioid painkillers available for those in need. Copyright (C) 2019 The Au thor(s). Published by Elsevier Ltd.