Trends in Opioid Prescribing and Dispensing by Veterinarians in Pennsylvania
Trends in Opioid Prescribing and Dispensing by Veterinarians in Pennsylvania
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DOI：
10.1001/jamanetworkopen.2018.6950
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发表时间：
2019-01-01
影响因子：
13.8
通讯作者：
Perrone, Jeanmarie
中科院分区：
文献类型：
--
作者：
Clarke, Dana L.;Drobatz, Kenneth J.;Perrone, Jeanmarie
重要性兽医是阿片类药物处方者的一个子集。目的评估宾夕法尼亚州费城一家大型兽医医院过去11年中几种不同阿片类药物处方和分发的数量和趋势。这项横断面研究清点了所有阿片类药物片剂和/或或由在费城的多专业学术兽医教学医院执业的兽医为小动物和物种，如兔子，鸟类和爬行动物，从2007年1月1日到2017年12月31日。通过审查研究期间受控物质的详细药房记录，从所有开具阿片类药物处方的兽医处获得处方数据。数据包括分发或处方给在中心接受评估或由医院兽医作为门诊患者随访的动物（患者）的所有阿片类药物。全州兽医处方数据用于比较。分析了2017年12月24日至2018年5月15日的数据。主要结局和指标11年研究期间4种特定阿片类镇痛药（硫酸可待因、重酒石酸氢可酮和盐酸曲马多片剂以及枸橼酸芬太尼贴剂）的给药和处方趋势。个别阿片类药物被转换为吗啡毫克当量（MME）comparation.Results的研究包括134兽医（70.9%的妇女）与366468患者访问。在研究期间，医院兽医为犬（73.0%）、猫（22.5%）和外来动物（4.5%）处方了1 051 836片曲马多、97 547片氢可酮、38 939片可待因和3153片芬太尼贴剂。总体而言，MME使用增加了41.2%，而访问增加了12.8%。宾夕法尼亚州的比较数据显示，氢可酮的使用占主导地位（688 340片处方），虽然数据无法与曲马多比较，因为它是一个附表IV药物。结论和相关性本研究的结果表明，大，阿片类药物的处方量不断增加，在1兽医教学医院突出的关注平行于那些过量的阿片类药物处方在人类。这些数据在一定程度上可能代表了来自美国各地普通兽医诊所和医院的相似处方量，这一点由所附的宾夕法尼亚州数据表明。这些发现强调了评估兽医阿片类药物处方风险以保障公共健康的机会。
IMPORTANCE Veterinarians are a subset of opioid prescribers.OBJECTIVE To assess the quantity and trends in prescribing and dispensing of several different opioids in the past 11 years in a large veterinary hospital in Philadelphia, Pennsylvania.DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study inventoried all opioid tablets and/or patches dispensed or prescribed by veterinarians practicing in a multispecialty academic veterinary teaching hospital in Philadelphia for small animals and species, such as rabbits, birds, and reptiles, from January 1, 2007, through December 31, 2017. Prescribing data were obtained from all veterinarians who wrote a prescription for opioids by reviewing detailed pharmacy records of controlled substances for the study period. Data included all opioids dispensed, or prescribed to animals (patients) undergoing evaluation at the center or being followed up as outpatients by the veterinarians in the hospital. Statewide veterinarian prescribing data were used for comparison. Data were analyzed from December 24, 2017, through May 15, 2018.MAIN OUTCOMES AND MEASURES The trend in administration and prescribing of 4 specific opioid analgesics (codeine sulfate, hydrocodone bitartrate, and tramadol hydrochloride tablets as well as fentanyl citrate patch) during the 11-year study period. The individual opioids were converted to morphine milligram equivalents (MME) for comparison.RESULTS The study included 134 veterinarians (70.9% women) with 366 468 patient visits. During the study period, the hospital veterinarians prescribed 1 051 836 tablets of tramadol, 97 547 tablets of hydrocodone, 38 939 tablets of codeine, and 3153 fentanyl patches to dogs (73.0%), cats (22.5%), and exotic animals (4.5%). Overall, MME use increased 41.2%, whereas visits increased by 12.8%. The comparison data for Pennsylvania revealed a predominance of hydrocodone use (688 340 tablets prescribed), although data were not available for comparison with tramadol because it is a Schedule IV drug.CONCLUSIONS AND RELEVANCE Results of this study suggest that the large, increasing volume of opioids prescribed at 1 veterinary teaching hospital highlights concerns parallel to those about excessive opioid prescribing in humans. The extent to which these data may represent similar volumes of prescriptions from the general veterinary practices and hospitals across the United States is suggested by the accompanying Pennsylvania state data. These findings highlight an opportunity to assess the risk of veterinarian opioid prescriptions to safeguard public health.