Opioid prescribing patterns and overdose deaths in Texas
Opioid prescribing patterns and overdose deaths in Texas
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DOI：
10.1080/08897077.2019.1675114
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发表时间：
2019-10-23
期刊：
影响因子：
3.5
通讯作者：
Langabeer, James R.
中科院分区：
文献类型：
--
作者：
Champagne-Langabeer, Tiffany;Madu, Renita;Langabeer, James R.
背景资料：阿片类药物使用障碍最近被宣布为公共卫生紧急事件，但目前尚不清楚阿片类药物处方模式是否随着时间的推移而发生变化。我们的目标是检查阿片类药物处方行为和过量死亡在一个大的国家之前，国家强制使用的处方药监测计划（PSTO）。研究方法：我们依赖于2013年至2017年德克萨斯州阿片类药物处方和过量死亡的州和国家数据库的去识别纵向数据。使用描述性统计和趋势分析评估随时间推移的比例差异和变化。结果：阿片类药物处方占整个期间分发的受控药物总量的45%以上。这相当于每年约有1770万张阿片类药物处方，或每100人63.7张阿片类药物处方，略低于报告的全国平均水平。氢可酮是最广泛使用的阿片类药物（32.9%），其次是曲马多（26.9%）和可待因（21.5%）。最近一年，受管制物质的总体处方率似乎在下降，类阿片的构成发生了变化。我们发现II类药物（如氢可酮和芬太尼）减少，IV类药物（如曲马多）增加。与此同时，在此期间，过量死亡总数增加了42%，人口调整后的死亡率增加了34%，达到每10万人5.87人死亡。结论：虽然德克萨斯州的处方率有所下降，但法律的和非法阿片类药物的过量死亡人数正在上升，这表明仅仅改变医生的处方行为可能不足以遏制这一流行病。应考虑采取政策和社区干预措施，以解决处方和非法类阿片死亡增加的问题。
Background: Opioid use disorder has recently been declared a public health emergency, yet it is unknown whether opioid prescribing patterns have changed over time. Our objective is to examine opioid prescribing behavior and overdose fatalities in one large state prior to state-mandated usage of a prescription drug monitoring program (PDMP). Methods: We relied on de-identified longitudinal data from state and national databases for opioid prescriptions and overdose deaths in Texas between 2013 and 2017. Descriptive statistics and trend analyses were used to assess proportional differences and changes over time. Results: Prescriptions for opioids represented over 45% of the total controlled medications dispensed across the entire period. This equates to roughly 17.7 million opioid prescriptions dispensed per year, or 63.7 opioid prescriptions per 100 persons, slightly less than the reported national average. Hydrocodone was the most widely prescribed opioid (32.9%), followed by tramadol (26.9%) and codeine (21.5%). The overall controlled substance prescribing rate appears to be decreasing in the latest year, and the composition of opioids has shifted. We found a reduction in schedule II medications (such as hydrocodone and fentanyl) and increase in schedule IV medications such as tramadol. At the same time, total overdose fatalities increased 42% during this time, and population-adjusted rates increased 34% to 5.87 deaths per 100,000 persons. Conclusions: While prescribing rates have decreased in Texas, overdose deaths from both legal and illicit opioids are rising, suggesting that changing physician prescribing behavior alone may not be sufficient to curb the epidemic. Policies and community interventions should be considered to address increases in both prescription and illicit opioid deaths.