Vital Signs: Changes in Opioid Prescribing in the United States, 2006-2015
Vital Signs: Changes in Opioid Prescribing in the United States, 2006-2015
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DOI：
10.15585/mmwr.mm6626a4
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发表时间：
2017-07-07
影响因子：
33.9
通讯作者：
Dowell, Deborah
中科院分区：
文献类型：
--
作者：
Guy, Gery P., Jr.;Zhang, Kun;Dowell, Deborah
1999-2010年期间，美国处方类阿片相关的过量死亡急剧增加，与类阿片处方增加平行。CDC评估了2006- 2015年国家级和县级阿片类药物处方的变化。方法：CDC分析了QuintilesIMS的零售处方数据，以评估2006 - 2015年美国阿片类药物处方，包括处方率、数量、剂量和持续时间。CDC检查了2010年和2015年的县级处方模式。结果：2010年美国阿片类药物处方量达到峰值，人均782吗啡毫克当量（MME），然后在2015年下降到人均640 MME。尽管大幅下降，但2015年的阿片类药物处方量仍约为1999年的三倍，并且全国各地差异很大。与处方阿片类药物量较高相关的县级因素包括：非西班牙裔白人比例较高;糖尿病和关节炎患病率较高;小城市地位（即，城市/城市; nonmetro）;失业率和医疗补助注册率上升。结论和对公共卫生实践的影响：尽管该国一些地区的阿片类药物处方量有所减少，但阿片类药物的处方量相对于1999年的水平仍然很高，并且在县一级差异很大。鉴于阿片类药物处方，阿片类药物使用障碍和过量服用率之间的关联，医疗保健提供者在临终关怀之外处方阿片类药物时应仔细权衡利益和风险，遵循循证指南，如CDC的慢性疼痛阿片类药物处方指南，并考虑非阿片类药物治疗慢性疼痛治疗。州和地方司法管辖区可以将这些发现与处方药监测计划数据相结合，以确定具有处方模式的区域，这些处方模式使患者面临阿片类药物使用障碍和过量的风险，并根据阿片类药物处方指南对处方者进行针对性干预。
Prescription opioid-related overdose deaths increased sharply during 1999-2010 in the United States in parallel with increased opioid prescribing. CDC assessed changes in national-level and county-level opioid prescribing during 2006-2015.Methods: CDC analyzed retail prescription data from QuintilesIMS to assess opioid prescribing in the United States from 2006 to 2015, including rates, amounts, dosages, and durations prescribed. CDC examined county-level prescribing patterns in 2010 and 2015.Results: The amount of opioids prescribed in the United States peaked at 782 morphine milligram equivalents (MME) per capita in 2010 and then decreased to 640 MME per capita in 2015. Despite significant decreases, the amount of opioids prescribed in 2015 remained approximately three times as high as in 1999 and varied substantially across the country. County-level factors associated with higher amounts of prescribed opioids include a larger percentage of non-Hispanic whites; a higher prevalence of diabetes and arthritis; micropolitan status (i.e., town/city; nonmetro); and higher unemployment and Medicaid enrollment.Conclusions and Implications for Public Health Practice: Despite reductions in opioid prescribing in some parts of the country, the amount of opioids prescribed remains high relative to 1999 levels and varies substantially at the county-level. Given associations between opioid prescribing, opioid use disorder, and overdose rates, health care providers should carefully weigh the benefits and risks when prescribing opioids outside of end-of-life care, follow evidence-based guidelines, such as CDC's Guideline for Prescribing Opioids for Chronic Pain, and consider nonopioid therapy for chronic pain treatment. State and local jurisdictions can use these findings combined with Prescription Drug Monitoring Program data to identify areas with prescribing patterns that place patients at risk for opioid use disorder and overdose and to target interventions with prescribers based on opioid prescribing guidelines.