Trends in use of opioids for chronic noncancer pain among individuals with mental health and substance use disorders: the TROUP study.
Trends in use of opioids for chronic noncancer pain among individuals with mental health and substance use disorders: the TROUP study.
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DOI：
10.1097/ajp.0b013e3181b99f35
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发表时间：
2010-01
期刊：
影响因子：
--
通讯作者：
Sullivan MD
中科院分区：
文献类型：
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作者：
Edlund MJ;Martin BC;Devries A;Fan MY;Braden JB;Sullivan MD
使用处方类阿片治疗慢性疼痛的情况正在增加，滥用这些药物的情况也在增加，尽管这些趋势之间的联系性质尚不清楚。这些增加可能在精神健康（MH）和物质使用障碍（SUD）患者中最为明显。我们分析了2000年至2005年期间非癌症疼痛状况（NCPC）患者（有和无MH和SUD）阿片类药物处方的趋势。二次数据分析的纵向管理数据，从两个不同的人群：一个国家，商业保险的人口，和阿肯色州医疗补助登记。我们检查了这些阿片类药物的结果：（1）过去一年中任何处方阿片类药物的使用率，（2）处方阿片类药物的长期使用率（过去一年中超过90天），（3）阿片类药物的平均供应天数，（4）吗啡当量的平均每日阿片类药物剂量，以及（5）附表II阿片类药物占阿片类药物总剂量的百分比。2000年，在NCPC患者中，MH或SUD患者的慢性阿片类药物使用比没有商业保险（8%对3%，p<0.001）和阿肯色州医疗补助（20%对13%，p<0.001）的患者更常见。在2000年至2005年期间，在商业保险中，患有MH或SUD的个人中慢性阿片类药物使用率增加了34.9%，而没有这些疾病的个人中增加了27.8%。在阿肯色州，医疗补助慢性阿片类药物使用在患有MH或SUD的个体中增加了55.4%，在没有MH或SUD的个体中增加了39.8%。慢性使用处方阿片类药物的NCPC是高得多，增长速度更快的MH和SUD患者比那些没有这些诊断。临床医生应监测这些弱势群体中处方阿片类药物的使用情况，以确定阿片类药物是否替代或干扰适当的精神健康和药物滥用治疗。
Use of prescription opioids for chronic pain is increasing, as is abuse of these medications, though the nature of the link between these trends is unclear. These increases may be most marked in patients with mental health (MH) and substance use disorders (SUDs). We analyzed trends between 2000 and 2005 in opioid prescribing among individuals with non-cancer pain conditions (NCPC), with and without MH and SUDs. Secondary data analysis of longitudinal administrative data from two dissimilar populations: a national, commercially-insured population, and Arkansas Medicaid enrollees. We examined these opioid outcomes: (1) Rates of any prescription opioid use in the past year, (2) rates of chronic use of prescription opioids (greater than 90 days in the past year), (3) mean days supply of opioids, (4) mean daily opioid dose in morphine equivalents, and (5) percentage of total opioid dose that was Schedule II opioids. In 2000, among individuals with NCPC, chronic opioid use was more common among those with a MH or SUD than those without in commercially insured (8% versus 3%, p<0.001) and Arkansas Medicaid (20% versus 13%, p<0.001). Between 2000 and 2005, in commercially insured, rates of chronic opioid use increased by 34.9% among individuals with an MH or SUD, and 27.8% among individuals without these disorders. In Arkansas Medicaid chronic opioid use increased 55.4% among individuals with an MH or SUD, and 39.8% among those without. Chronic use of prescription opioids for NCPC is much higher and growing faster in patients with MH and SUDs than those without these diagnoses. Clinicians should monitor use of prescription opioids in these vulnerable groups to determine whether opioids are substituting for or interfering with appropriate mental health and substance abuse treatment.