Opioid Prescriptions in Older Medicare Beneficiaries After the 2014 Federal Rescheduling of Hydrocodone Products
Opioid Prescriptions in Older Medicare Beneficiaries After the 2014 Federal Rescheduling of Hydrocodone Products
复制标题
DOI：
10.1111/jgs.15332
复制
发表时间：
2018-05-01
影响因子：
6.3
通讯作者：
Goodwin, James S.
中科院分区：
文献类型：
--
作者：
Kuo, Yong-Fang;Raji, Mukaila A.;Goodwin, James S.
目的：研究2014年10月美国药品监督管理局将氢可酮产品从附表III重新分类为II的政策如何影响老年人，他们是美国处方阿片类药物的最大消费者。设计：回顾性队列研究。地点：美国。参与者：从2013年到2015年，20%的65岁及以上的Medicare Part D受益人样本（每年超过2，500，000人受益）从2013年1月到2015年12月，我们计算了阿片类药物处方的每月患病率以及接受90天或更长时间处方的个人患病率结果：从2013年到2015年，在一年内接受氢可酮处方的医疗保险D部分登记者的比例从21.9%下降到18.3%。氢可酮处方的月费率在2014年大幅下降。在多变量分析中，2015年与2013年相比，接受长期阿片类药物处方的风险降低了约7%（患病率= 0.93，95%置信区间（CI）= 0.93-0.94）。由于残疾或符合医疗补助资格而获得原始权利的医疗保险登记者在长期处方方面减少较少，并且出乎意料地，高剂量处方略有增加。阿片类药物相关的住院治疗没有显著变化，但没有记录阿片类药物处方的阿片类药物相关的住院治疗增加（比值比= 1.24，95% CI = 1.03-1.50）结论：2014年氢可酮从III期到II期的变化与老年人阿片类药物使用率的适度下降有关。阿片类药物相关住院治疗的意外增加，而没有记录的阿片类药物处方可能代表非法使用的增加。
OBJECTIVES: To examine how an October 2014 Drug Enforcement Administration policy reclassified hydrocodone product from schedule III to II has affected older adults, who are among the largest consumers of prescription opioids in the United States.DESIGN: Retrospective cohort study.SETTING: United States.PARTICIPANTS: A 20% sample of Medicare Part D beneficiaries aged 65 and older from 2013 through 2015 (> 2,500,000 beneficiaries each year)MEASUREMENTS: From January 2013 to December 2015, we calculated the monthly prevalence of opioid prescriptions and the prevalence of individuals who received prescriptions for a 90-day supply or longer (prolonged), as well as hospitalizations related to opioid toxicity in 2013 and 2015.RESULTS: From 2013 to 2015, the proportion of Medicare Part D enrollees who received a hydrocodone prescription in a year decreased from 21.9% to 18.3%. Monthly rates for hydrocodone prescriptions declined significantly in 2014. The risk of receiving prolonged opioid prescriptions decreased by approximately 7% in the multivariable analyses comparing 2015 to 2013 (prevalence ratio = 0.93, 95% confidence interval (CI) = 0.93-0.94). Medicare enrollees with an original entitlement because ofdisability or with Medicaid eligibility had smaller decreases in prolonged prescriptions and, unexpectedly, small increases in high-dose prescriptions. Opioid-related hospitalizations did not change significantly, but opioid-related hospitalizations without a documented opioid prescription increased (odds ratio = 1.24, 95% CI = 1.03-1.50).CONCLUSION: The 2014 change in hydrocodone from schedule III to schedule II was associated with modest decreases in rates of opioid use in the elderly. The unexpected increase in opioid-related hospitalizations without documented opioid prescriptions may represent an increase in illegal use.