Opioid Use Patterns Among Active Duty Service Members and Civilians: 2006-2014
Opioid Use Patterns Among Active Duty Service Members and Civilians: 2006-2014
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DOI：
10.1093/milmed/usx014
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发表时间：
2018-03-01
影响因子：
1.2
通讯作者：
Potter, Jennifer S.
中科院分区：
文献类型：
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作者：
Kazanis, William;Pugh, Mary J.;Potter, Jennifer S.
简介：2001 年至 2009 年间，军事卫生系统的阿片类镇痛处方增加了四倍，达到 380 万张。可用的阿片类镇痛药的绝对数量为误用、滥用和转移相关问题奠定了基础。为了解决这个问题，国防部实施了多项指令和临床指南，以改善获得适当疼痛护理和安全阿片类药物处方的机会。不幸的是，我们很少研究现役军人 (ADSM) 中阿片类药物使用模式的变化，因此我们对作战行动和军事医疗保健政策如何影响这一重大问题知之甚少。我们研究了 2006 年至 2014 年间用于 ADSM 的阿片类药物使用的变化，与平民人口进行了比较，并探讨了军事特定因素在军事卫生系统阿片类药物使用变化中的潜在作用。材阿片类药物使用前后的趋势。我们使用自回归预测模型来验证 2011 年前后阿片类药物使用模式的变化。几个中断时间序列模型检查了军事系统级因素是否与阿片类药物使用变化相关。结果：2006 年至 2014 年间，1,516,979 名 ADSM 配药了 7,119,945 份阿片类药物处方，无论是在军事治疗设施中还是通过 TRICARE 购买。 2011 年之后，现役军人和平民都显示出使用量减少的迹象，但这种变化在 ADSM 中更为明显。预测模型显示 2011 年之后 ADSM 填写阿片类药物处方的预计比例与实际比例之间存在显着差异，证实 2011 年是阿片类药物使用的分歧点。间断时间序列模型表明，偏转点与显着下降相关。一个月内，每 1,000 名行动伤员的阿片类药物处方量显着增加 0.261%。从持久自由行动、伊拉克自由行动或新黎明行动中返回的部队似乎没有影响使用率。即使在考虑了从持久自由行动/伊拉克自由行动/新黎明行动中返回的部队和行动中受伤的人数后，偏转点仍与服用阿片类药物处方的 ADSM 比例较低有关，导致观察期结束时（2014 年 12 月）下降了 1.61%。结论：2011 年 12 月之后，平民和 ADSM 人群中阿片类药物的使用模式显着减少，但军人人群的情况更为明显。许多因素，例如行动中受伤的人数和军事卫生系统的结构组织，可能导致了下降，尽管下降很可能受到军队内外许多因素的影响，包括政策指令和文化变化。
Introduction: Between 2001 and 2009, opioid analgesic prescriptions in the Military Health System quadrupled to 3.8 million. The sheer quantity of opioid analgesics available sets the stage for issues related to misuse, abuse, and diversion. To address this issue, the Department of Defense implemented several directives and clinical guidelines to improve access to appropriate pain care and safe opioid prescribing. Unfortunately, little has been done to characterize changing patterns of opioid use in active duty service members (ADSM), so little is known about how combat operations and military health care policy may have influenced this significant problem. We examined changes in opioid use for ADSM between 2006 and 2014, compared trends with the civilian population, and explored the potential role of military-specific factors in changes in opioid use in the Military Health System. Materials and Methods: After obtaining Institutional Review Board approval, administrative prescription records (Pharmacy Data Transaction Records) for non-deployed ADSM were used to determine the number of opioid prescriptions dispensed each year and the proportion of ADSM who received at least one prescription per month between 2006 and 2014. Based on the observation and the literature, we identified December 2011 as the demarcation point (the optimal point to identify the downturn in opioid use) and used it to compare opioid use trends before and after. We used an auto-regressive forecast model to verify changes in opioid use patterns before and after 2011. Several interrupted time series models examined whether military system-level factors were associated with changes in opioid use. Results: Between 2006 and 2014, 1,516,979 ADSM filled 7,119,945 opioid prescriptions, either in military treatment facilities or purchased through TRICARE. Both active duty and civilian populations showed signs of decreasing use after 2011, but this change was much more pronounced among ADSM. The forecast model showed a significant difference after 2011 between the projected and actual proportion of ADSM filling an opioid prescription, confirming 2011 as a point of divergence in opioid use. Interrupted time series models showed that the deflection point was associated with significant decreases. A significant increase of 0.261% in opioid prescriptions was seen for every 1,000 wounded in action service members in a given month. Troops returning from Operation Enduring Freedom, Operation Iraqi Freedom, or Operation New Dawn did not appear to influence the rates of use. Even after accounting for returning troops from Operation Enduring Freedom/Operation Iraqi Freedom/ Operation New Dawn and wounded in action counts, the deflection point was associated with a lower proportion of ADSM who filled an opioid prescription, leading to a decrease of 1.61% by the end of the observation period (December 2014). Conclusion: After December 2011, opioid use patterns significantly decreased in both civilian and ADSM populations, but more so in the military population. Many factors, such as numbers of those wounded in action and the structural organization of the Military Health System, may have caused the decline, although more than likely the decrease was influenced by many factors inside and outside of the military, including policy directives and cultural changes.