Rates of Opioid Dispensing and Overdose After Introduction of Abuse-Deterrent Extended-Release Oxycodone and Withdrawal of Propoxyphene
Rates of Opioid Dispensing and Overdose After Introduction of Abuse-Deterrent Extended-Release Oxycodone and Withdrawal of Propoxyphene
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DOI：
10.1001/jamainternmed.2015.0914
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发表时间：
2015-06-01
影响因子：
39
通讯作者：
Wharam, J. Frank
中科院分区：
文献类型：
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作者：
Larochelle, Marc R.;Zhang, Fang;Wharam, J. Frank
重要性2010年下半年，推出了抗滥用缓释盐酸羟考酮（奥施康定;普渡制药），并从美国市场撤回了丙氧芬。这些药物市场的变化对阿片类药物配药和过量率的影响是unknow.Objective评估阿片类药物市场和阿片类药物配药和过量rate.DESIGN，设置，和参与者之间的关联从一个大型的国家美国健康保险公司的索赔进行了分析，使用中断的时间序列研究设计。参与者包括2003年1月1日至2012年12月31日期间年龄在18至64岁之间的3130万商业保险成员的开放队列，中位随访时间为20个月（最后一次随访，2012年12月31日）。（抗压碎或溶解），丙氧芬于2010年11月19日退出市场。主要结局和指标：标准化阿片类药物分发率和处方阿片类药物和海洛因过量率是主要结局。我们使用分段回归分析结果的变化，从30个季度前到8个季度后，2 interventions.Results阿片类药物市场的变化后两年，总阿片类药物的分配减少了19%，从预期的速度（绝对变化，-32.2毫克吗啡当量剂量每个成员每季度[95%CI，-38.1至-26.3]）。按阿片类药物亚型划分，2年时每个成员每季度吗啡当量剂量的绝对变化为-11.3（95% CI，-12.4至-10.1）羟考酮缓释剂，3.26（95% CI，1.40至5.12），丙氧芬为-8.19（95% CI，-9.30至-7.08），其他速释阿片为-16.2（95% CI，-18.8至-13.5）。市场变化两年后，估计处方阿片类药物过量率下降了20%（绝对变化，每10万人每季度-1.10人[95% CI，-1.47至-0.74]），但海洛因过量增加了23%（绝对变化，每季度每10万名成员中有0.26人[95%CI，-0.01至0.53]）。结论和相关性在2010年底药品市场发生两次重大变化后，阿片类药物配药和处方阿片类药物过量大幅减少。药物市场干预可能对打击处方阿片类药物过量流行有价值，但海洛因过量率继续增加。迫切需要识别和治疗阿片类药物滥用和成瘾的补充战略。
IMPORTANCE In the second half of 2010, abuse-deterrent extended-release oxycodone hydrochloride (OxyContin; Purdue Pharma) was introduced and propoxyphene was withdrawn from the US market. The effect of these pharmaceutical market changes on opioid dispensing and overdose rates is unknown.OBJECTIVE To evaluate the association between 2 temporally proximate changes in the opioid market and opioid dispensing and overdose rates.DESIGN, SETTING, AND PARTICIPANTS Claims from a large national US health insurer were analyzed, using an interrupted time series study design. Participants included an open cohort of 31.3 million commercially insured members aged 18 to 64 years between January 1, 2003, and December 31, 2012, with median follow-up of 20 months (last follow-up, December 31, 2012).EXPOSURES Introduction of abuse-deterrent OxyContin (resistant to crushing or dissolving) on August 9, 2010, and market withdrawal of propoxyphene on November 19, 2010.MAIN OUTCOMES AND MEASURES Standardized opioid dispensing rates and prescription opioid and heroin overdose rates were the primary outcomes. We used segmented regression to analyze changes in outcomes from 30 quarters before to 8 quarters after the 2 interventions.RESULTS Two years after the opioid market changes, total opioid dispensing decreased by 19% from the expected rate (absolute change, -32.2 mg morphine-equivalent dose per member per quarter [95% CI, -38.1 to -26.3]). By opioid subtype, the absolute change in dispensing by milligrams of morphine-equivalent dose per member per quarter at 2 years was -11.3 (95% CI, -12.4 to -10.1) for extended-release oxycodone, 3.26 (95% CI, 1.40 to 5.12) for other long-acting opioids, -8.19 (95% CI, -9.30 to -7.08) for propoxyphene, and -16.2 (95% CI, -18.8 to -13.5) for other immediate-release opioids. Two years after the market changes, the estimated overdose rate attributed to prescription opioids decreased by 20% (absolute change, -1.10 per 100 000 members per quarter [95% CI, -1.47 to -0.74]), but heroin overdose increased by 23% (absolute change, 0.26 per 100 000 members per quarter [95% CI, -0.01 to 0.53]).CONCLUSIONS AND RELEVANCE Opioid dispensing and prescription opioid overdoses decreased substantially after 2 major changes in the pharmaceutical market in late 2010. Pharmaceutical market interventions may have value in combatting the prescription opioid overdose epidemic, but heroin overdose rates continue to increase. Complementary strategies to identify and treat opioid abuse and addiction are urgently needed.