Vital Signs: Pharmacy-Based Naloxone Dispensing - United States, 2012-2018
Vital Signs: Pharmacy-Based Naloxone Dispensing - United States, 2012-2018
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DOI：
10.15585/mmwr.mm6831e1
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发表时间：
2019-08-09
影响因子：
33.9
通讯作者：
Jones, Christopher M.
中科院分区：
文献类型：
--
作者：
Guy, Gery P., Jr.;Haegerich, Tamara M.;Jones, Christopher M.
背景资料：CDC关于慢性疼痛阿片类药物处方的指南建议，当存在增加过量风险的因素时（例如，用药过量或物质使用障碍史，阿片类药物剂量≥ 50毫克吗啡当量/天[高剂量]，同时使用苯二氮卓类药物）。鉴于涉及阿片类药物的药物过量死亡人数众多，其中36%在2017年涉及处方阿片类药物，改善纳洛酮的可及性是公共卫生的优先事项。CDC研究了美国国家和县级零售药店纳洛酮配药的趋势和特点。方法：CDC分析了来自医疗保健、数据科学和技术公司IQVIA的2012-2018年零售药店数据，以评估美国人口普查地区、城市/农村状况、处方者专业和接受者特征（包括年龄组、性别、自付费用和付款方式。结果：从零售药店分发的纳洛酮处方数量从2012年到2018年大幅增加，其中仅从2017年到2018年就增加了106%。在全国范围内，2018年，每69个高剂量阿片类药物处方中就有一个纳洛酮处方。发现纳洛酮分配存在很大的区域差异，包括各县之间的25倍差异，大多数农村县的比率最低。处方者的专业也存在很大差异。与纳洛酮处方支付与医疗补助和商业保险相比，更大比例的处方支付与医疗保险需要自付costs.Conclusion：尽管纳洛酮配药大幅增加，纳洛酮处方分配每高剂量阿片类药物处方的比率仍然很低，和整体纳洛酮配药在全国各地有很大差异。纳洛酮的分布是公共卫生应对阿片类药物过量流行病的重要组成部分。当存在过量风险因素时，卫生保健提供者可以开具或分发纳洛酮，并建议患者如何使用它。改善纳洛酮获得和分配的努力最有效地与改善阿片类药物处方的努力一起工作，实施其他减少危害的策略，促进与阿片类药物使用障碍治疗药物的联系，并加强公共卫生和公共安全伙伴关系。
Background: The CDC Guideline for Prescribing Opioids for Chronic Pain recommends considering prescribing naloxone when factors that increase risk for overdose are present (e.g., history of overdose or substance use disorder, opioid dosages >= 50 morphine milligram equivalents per day [high-dose], and concurrent use of benzodiazepines). In light of the high numbers of drug overdose deaths involving opioids, 36% of which in 2017 involved prescription opioids, improving access to naloxone is a public health priority. CDC examined trends and characteristics of naloxone dispensing from retail pharmacies at the national and county levels in the United States.Methods: CDC analysed 2012-2018 retail pharmacy data from IQVIA, a health care, data science, and technology company, to assess U.S. naloxone dispensing by U.S. Census region, urban/rural status, prescriber specialty, and recipient characteristics, including age group, sex, out-of-pocket costs, and method of payment. Factors associated with naloxone dispensing at the county level also were examined.Results: The number of naloxone prescriptions dispensed from retail pharmacies increased substantially from 2012 to 2018, including a 106% increase from 2017 to 2018 alone. Nationally, in 2018, one naloxone prescription was dispensed for every 69 high-dose opioid prescriptions. Substantial regional variation in naloxone dispensing was found, including a twenty-fivefold variation across counties, with lowest rates in the most rural counties. A wide variation was also noted by prescriber specialty. Compared with naloxone prescriptions paid for with Medicaid and commercial insurance, a larger percentage of prescriptions paid for with Medicare required out-of-pocket costs.Conclusion: Despite substantial increases in naloxone dispensing, the rate of naloxone prescriptions dispensed per high-dose opioid prescription remains low, and overall naloxone dispensing varies substantially across the country. Naloxonc distribution is an important component of the public health response to the opioid overdose epidemic. Health care providers can prescribe or dispense naloxonc when overdose risk factors arc present and counsel patients on how to use it. Efforts to improve naloxone access and distribution work most effectively with efforts to improve opioid prescribing, implement other harm-reduction strategies, promote linkage to medications for opioid use disorder treatment, and enhance public health and public safety partnerships.