Trends in medical use and abuse of opioid analgesics
Trends in medical use and abuse of opioid analgesics
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DOI：
10.1001/jama.283.13.1710
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发表时间：
2000-04-05
影响因子：
120.7
通讯作者：
Dahl, JL
中科院分区：
文献类型：
--
作者：
Joranson, DE;Ryan, KM;Dahl, JL
背景疼痛通常没有得到充分的治疗，部分原因是不愿意使用阿片类镇痛药，担心它们会被滥用。虽然国际和国家专家组已确定阿片类镇痛药是必不可少的缓解疼痛，很少有资料已对滥用这些drugs.Objective的健康后果有关的药物滥用的比例和滥用的趋势，阿片类镇痛药的医疗使用和滥用用于治疗严重疼痛：芬太尼，氢吗啡酮，哌替啶，吗啡，设计和设置回顾性调查1990年至1996年的医疗记录存储在药物滥用预警网络的数据库（滥用数据的来源）和报告和综合命令自动化系统（医疗使用数据来源）患者因药物滥用而入院的急诊科患者的全国代表性样本。主要结果测量医疗使用量（克）和每100人的克数结果1990 ~ 1996年，吗啡的医疗使用呈上升趋势，（59%; 220万至350万克），芬太尼（1168%; 3263 - 41371 g），羟考酮（23%; 160万至200万g）和氢吗啡酮（19%; 118 455至141 325克），以及哌替啶的医疗使用减少（35%; 520万至340万克）。在同一时期，每年因阿片类镇痛剂而提及的药物滥用总数从32 430增加到34 563（6.6%），尽管阿片类药物滥用相对于药物滥用提及总数的比例从5.1%下降到3.8%。哌替啶滥用报告减少（39%; 1335 - 806），羟考酮（29%; 4526至3190），芬太尼（59%; 59至24），和氢吗啡酮（15%; 718至609），吗啡增加结论阿片类镇痛药治疗疼痛的医疗使用增加的趋势似乎并没有导致阿片类镇痛药滥用的健康后果增加。
Context Pain often is inadequately treated due in part to reluctance about using opioid analgesics and fear that they will be abused. Although international and national expert groups have determined that opioid analgesics are essential for the relief of pain, little information has been available about the health consequences of the abuse of these drugs.Objective To evaluate the proportion of drug abuse related to opioid analgesics and the trends in medical use and abuse of 5 opioid analgesics used to treat severe pain: fentanyl, hydromorphone, meperidine, morphine, and oxycodone.Design and Setting Retrospective survey of medical records from 1990 to 1996 stored in the databases of the Drug Abuse Warning Network (source of abuse data)and the Automation of Reports and Consolidated Orders System (source of medical use data).Patients Nationally representative sample of hospital emergency department admissions resulting from drug abuse.Main Outcome Measures Medical use in grams and grams per 100 000 population and mentions of drug abuse by number and percentage of the population.Results From 1990 to 1996, there were increases in medical use of morphine (59%; 2.2 to 3.5 million g), fentanyl (1168%; 3263 to 41 371 g), oxycodone (23%; 1.6 to 2.0 million g), and hydromorphone (19%; 118 455 to 141 325 g), and a decrease in the medical use of meperidine (35%; 5.2 to 3.4 million g). During the same period, the total number of drug abuse mentions per year due to opioid analgesics increased from 32 430 to 34 563 (6.6%), although the proportion of mentions for opioid abuse relative to total drug abuse mentions decreased from 5.1% to 3.8%. Reports of abuse decreased for meperidine (39%; 1335 to 806), oxycodone (29%; 4526 to 3190), fentanyl (59%; 59 to 24), and hydromorphone (15%; 718 to 609), and increased for morphine (3%; 838 to 865).Conclusions The trend of increasing medical use of opioid analgesics to treat pain does not appear to contribute to increases in the health consequences of opioid analgesic abuse.