Prescribing of opioid analgesics and related mortality before and after the introduction of long-acting oxycodone
Prescribing of opioid analgesics and related mortality before and after the introduction of long-acting oxycodone
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DOI：
10.1503/cmaj.090784
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发表时间：
2009-12-08
影响因子：
14.6
通讯作者：
Juurlink, David N.
中科院分区：
文献类型：
--
作者：
Dhalla, Irfan A.;Mamdani, Muhammad M.;Juurlink, David N.
简介：加拿大与阿片类药物相关的死亡率似乎正在上升。我们研究了问题的真实程度以及引入长效羟考酮的影响。方法：我们研究了 1991 年至 2007 年安大略省阿片类镇痛药处方的趋势。我们回顾了 1991 年至 2004 年间与阿片类药物使用相关的所有死亡。我们将其中 3271 例死亡与管理数据联系起来，以检查患者死前使用医疗保健服务的情况。通过时间序列分析，我们确定了 2000 年 1 月在省药品处方中添加长效羟考酮是否与阿片类药物相关死亡率的增加有关。结果：从 1991 年到 2007 年，阿片类药物的年度处方从每 1000 人 458 份增加到 591 份。阿片类药物相关死亡人数翻了一番，从 1991 年的每百万人 13.7 人增加到 2004 年的每百万人 27.2 人。1991 年至 2007 年间，羟考酮处方增加了 850%。在药物处方中添加长效羟考酮与羟考酮相关死亡率增加 5 倍（p < 0.01），死亡率增加 41%。阿片类药物相关死亡率总体增加 (p = 0.02)。验尸官认为 54.2% 的死亡方式为非故意死亡，21.9% 的死亡方式不确定。死亡前一个月使用医疗保健服务的情况很常见：例如，在可获得就医数据的 3066 名患者中，66.4% 的人在死亡前一个月曾就医；在可获得个人处方数据的 1095 名患者中，56.1% 的患者在死亡前一个月服用过阿片类药物处方。解读：自 1991 年以来，安大略省与阿片类药物相关的死亡人数显着增加。其中很大一部分增加与长效羟考酮添加到省药物处方集中有关。大多数死亡被认为是非故意的。死亡前一个月去看医生和开阿片类药物的频率表明错过了预防机会。
Introduction: Opioid-related mortality appears to be increasing in Canada. We examined the true extent of the problem and the impact of the introduction of long-acting oxycodone.Methods: We examined trends in the prescribing of opioid analgesics in the province of Ontario from 1991 to 2007. We reviewed all deaths related to opioid use between 1991 and 2004. We linked 3271 of these deaths to administrative data to examine the patients' use of health care services before death. Using time-series analysis, we determined whether the addition of long-acting oxycodone to the provincial drug formulary in January 2000 was associated with an increase in opioid-related mortality.Results: From 1991 to 2007, annual prescriptions for opioids in creased from 458 to 591 per 1000 individuals. Opioid-related deaths doubled, from 13.7 per million in 1991 to 27.2 per million in 2004. Prescriptions of oxycodone increased by 850% between 1991 and 2007. The addition of long-acting oxycodone to the drug formulary was associated with a 5-fold increase in oxycodone-related mortality (p < 0.01) and a 41% increase in overall opioid-related mortality (p = 0.02). The manner of death was deemed unintentional by the coroner in 54.2% and undetermined in 21.9% of cases. Use of health care services in the month before death was common: for example, of the 3066 patients for whom data on physician visits were available, 66.4% had visited a physician in the month before death; of the 1095 patients for whom individual-level prescribing data were available, 56.1% had filled a prescription for an opioid in the month before death.Interpretation: Opioid-related deaths in Ontario have in creased markedly since 1991. A significant portion of the increase was associated with the addition of long-acting oxycodone to the provincial drug formulary. Most of the deaths were deemed unintentional. The frequency of visits to a physician and prescriptions for opioids in the month before death suggests a missed opportunity for prevention.