Evaluation of the prescription amount of narcotic analgesics based on cancer pain relief management
Evaluation of the prescription amount of narcotic analgesics based on cancer pain relief management
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DOI：
10.1093/eurpub/ckac131.281
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发表时间：
2022-10-25
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日本制定了促进癌症患者疼痛缓解管理的基本计划，并正在推广正确使用麻醉性止痛药来缓解癌症疼痛。我们的目的是探索癌症患者年龄与阿片类药物剂量之间的关系，并在日本的一个全国队列中检查医疗系统和社会政策对防止阿片类药物滥用和成瘾的影响。数据从2014年4月至2019年3月从日本全国医疗保险索赔开放数据库中收集。收集了鸦片生物碱和合成麻醉剂的处方数据。根据年龄组和院内或院外处方数量(Mg)进行多因素Logistic回归分析，考虑变量之间假设关系的阿片类药物年处方数量的等效性。阿片生物碱处方的年平均用量在6年内逐渐减少2.8%(mg=10,249,115)，尤其是在住院处方中。院内合成毒品年处方增加24.1%(mg=2,135,568)，院外阿片生物碱增加1.3%(mg=37,565,229)，合成麻醉药品增加25.9%(mg=1,404,641)。在人口统计学变量中，65岁或65岁以上的癌症患者与阿片类药物变量的类型(p<；.001)和每年处方剂量的减少(p<；.001)显著相关。在所调查的年份中，门诊患者中使用鸦片生物碱和合成麻醉剂的治疗有所增加；然而，这一趋势在不同年龄组之间有所不同。我们的发现表明，早期发现和治疗的改进导致癌症患者幸存者的数量增加，从而导致麻醉性止痛剂剂量的增加。癌症患者的姑息治疗将有助于作为流行病学指标来审查循证健康相关对公共健康的影响。·还应考虑除医疗干预之外的 治疗，同时考虑到由于癌症存活率增加而导致的门诊阿片类药物处方接受者人数的增加。· 预防癌症止痛期间阿片类药物滥用的社会干预措施将促进临床医生和当地社区之间的合作，从而有助于预防药物滥用。
A basic plan for promoting pain relief management for cancer patients was formulated in Japan, and proper use of narcotic analgesics is being promoted to relieve cancer pain. We aimed to explore the relationship between age and opioid narcotic dose in cancer patients and examine the effects of healthcare systems and social policies to prevent opioid abuse and addiction in a national cohort in Japan. Data were collected from April 2014 to March 2019 from the nationwide health insurance claims open database in Japan. Prescription data were collected for opium alkaloids and synthetic narcotics. A multivariate logistic regression analysis was performed based on the age groups and in- or out-of-hospital prescription quantities (mg), taking into account equivalences in quantities of opioids prescribed yearly on the hypothesized relationships between variables. The average annual quantities of opium alkaloid prescribed gradually decreased by 2.8% (mg = 10,249,115) over six years, especially in in-hospital prescriptions. On the other hand, in-hospital annual prescriptions of synthetic narcotics increased by 24.1% (mg = 2,135,568), out-of-hospital opium alkaloid by 1.3% (mg = 37,565,229), and synthetic narcotics by 25.9% (mg = 1,404,641). Among the demographic variables, cancer patients aged 65 years or older were significantly associated with the types of opioid variables (p < .001) and annual reductions in prescribed amounts (p < .001). Treatment with opium alkaloids and synthetic narcotics increased among outpatients in the years examined; however, the trend varied across age groups. Our findings suggest that improvements in early detection and treatment have resulted in a rise in the number of cancer patient survivors, thereby leading to an increase in narcotic analgesic dose. The palliative care for cancer patients will contribute as an epidemiological indicator to review the evidence-based health-related impact on public health. • Treatments other than medical intervention should also be considered, taking into account the increase in the number of outpatient opioid prescription recipients due to increased cancer survival. • Social interventions to prevent opioid abuse during cancer pain relief will contribute to preventing substance abuse by promoting collaboration between clinicians and local communities.