Sources of Prescription Opioids for Nonmedical Use.
Sources of Prescription Opioids for Nonmedical Use.
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非医疗用途处方阿片类药物的来源。
DOI：
10.1097/adm.0000000000000192
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发表时间：
2016
影响因子：
5.5
通讯作者：
Hopfer,ChristianJ
中科院分区：
文献类型：
--
作者：
Bartels,Karsten;Binswanger,IngridA;Hopfer,ChristianJ
致编辑：阿片类药物的销售在过去十年中急剧增加（Dart等人，2015）。在一个令人不安的平行发展中，处方阿片类药物导致的死亡已成为一般人群死亡的主要原因，仅在2010年就夺走了16，000多人的生命（Jones等人，2013年）的报告。鉴于这些发现，已提出在改善疼痛管理的同时限制不必要的处方药物，作为改善当前阿片类药物处方实践的关键策略（Wavelow和McLellan，2011）。在最近一期的杂志上，Bouland et al.（2015）报告了他们关于已知物质使用障碍患者获得受控物质的模式和来源的发现。他们的调查集中在从医生那里获得受控物质的患者身上。他们发现，在61.1%的病例中，初级保健医生被认为是最容易获得受控物质的人，其次是22%的疼痛管理专家。正如作者指出的那样，大多数接受研究筛选的患者都是“从街上”获得受控物质的，因此没有资格参加调查。“从街上”指的是来源，如经销商，朋友，或家庭成员（自愿或被盗）。事实上，这与全国药物使用和健康调查的数据一致，表明在绝大多数（70.6%）病例中，用于非医疗用途的阿片类止痛药是从朋友或亲戚那里获得的（Jones等人，2014）。有趣的是，在54.4%的情况下，他们自愿和免费易手，尽管这种情况在服用高剂量的人中发生的频率较低，购买阿片类止痛药更为常见。对于40岁以上的人群，全科医生构成阿片类药物处方者的最大群体（30.4%）（Wavelow等人，2011年），鉴于它们是最常见的专业，这可能并不令人惊讶。然而，其他专业，如急诊医学、整形外科、牙科和产科/妇科，也是重要的阿片类药物处方者，并且在10至29岁的患者中，总体上大大超过全科医生（Wavelow等人，2011年）。特别地，在急性护理环境中，例如在门诊手术后，阿片类药物通常以“一刀切”的模式开处方，导致对大多数患者过度开阿片类药物（Rodgers等人，2012; Harris等人，2013年）的报告。这种剩余的阿片类药物很少被安全地储存或适当地返回（田边等人，2012年）。易受伤害的患者群体，如青少年，特别容易发生药物使用障碍（Grant和Dawson，1998年）。因此，对于包括所有年龄段患者在内的临床背景下的所有医学专业来说，安全有效的受控物质处方实践应该是一个优先事项。Bouland等人对我们理解直接从医生那里不适当地获得受控物质的模式做出了重要贡献。对受控物质承担更广泛的责任，包括
To the Editor: S ales of opioid medications have drastically increased in the past decade (Dart et al., 2015). In a disturbingly parallel development, deaths from prescription opioids have emerged as a primary cause of death in the general population, taking the lives of more than 16,000 people in 2010 alone (Jones et al., 2013). In light of these findings, limiting unnecessarily prescribed medications while improving pain management has been proposed as a key strategy for improving current opioid prescription practices (Volkow and McLellan, 2011). In the recent issue of the Journal, Bouland et al.(2015) report their findings on patterns and sources for obtaining controlled substances by patients with known substance use disorders. Their survey focused on patients who obtained their controlled substances from physicians. They found that primary care physicians were perceived as the easiest persons from whom to obtain controlled substances in 61.1% of cases, followed by 22% for pain management specialists. As the authors point out, the majority of patients screened for their study obtained their controlled substances ‘‘from the street’’and were therefore ineligible to take the survey.‘‘From the street’’referred to sources such as a dealer, friend, or family member (given consensually or stolen). Indeed, this is consistent with data from the National Survey on Drug Use and Health, indicating that opioid pain relievers for nonmedical use are obtained from a friend or a relative in the vast majority (70.6%) of cases (Jones et al., 2014). Interestingly, they change hands consensually and for free in 54.4% of cases, although this occurs less frequently among people who take high doses, where buying opioid pain relievers is more common.Assigning medical provider sources for ‘‘from the street’’controlled substances is not straightforward. General practitioners compose the largest aggregate (30.4%) of opioid prescribers for those older than 40 years of age (Volkow et al., 2011), which, given they are the most common specialty, may not come as a surprise. However, other specialties, such as emergency medicine, orthopedic surgery, dentistry, and obstetrics/gynecology, are also significant opioid prescribers and in aggregate greatly outweigh general practitioners in 10 to 29-year-old patients (Volkow et al., 2011). Especially, in acute care settings, such as after ambulatory surgery, opioids are often prescribed in a ‘‘one-size-fitsall’’pattern, leading to overprescription of opioids to the majority of patients (Rodgers et al., 2012; Harris et al., 2013). Such leftover opioids are rarely stored securely or returned appropriately (Tanabe et al., 2012). Vulnerable patient populations, such as adolescents, are especially at risk for the development of substance use disorders (Grant and Dawson, 1998). Safe and effective prescribing practices for controlled substances should therefore be a priority for all medical specialties across clinical contexts that include patients of all ages. Bouland et al. made an important contribution toward our understanding of patterns to inappropriately obtain controlled substance directly from physicians. Taking broader responsibility for controlled substances, including