Decline in Prescription Opioids Attributable to Decreases in Long-Term Use: A Retrospective Study in the Veterans Health Administration 2010-2016
Decline in Prescription Opioids Attributable to Decreases in Long-Term Use: A Retrospective Study in the Veterans Health Administration 2010-2016
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DOI：
10.1007/s11606-017-4283-8
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发表时间：
2018-06-01
影响因子：
5.7
通讯作者：
Lund, Brian C.
中科院分区：
文献类型：
--
作者：
Hadlandsmyth, Katherine;Mosher, Hilary;Lund, Brian C.
更好地了解短期和长期阿片类药物处方的时间趋势可能会为遏制阿片类药物流行病的努力提供信息。旨在描述 2010 年至 2016 年退伍军人健康管理局 (VHA) 中短期和长期阿片类药物处方的流行率。使用 VHA 数据库进行观察性队列研究。在 2010 年至 2016 年期间，所有患者通过 VHA 至少接受一份门诊处方。 2010 年至 2016 年阿片类药物的使用情况，按短期、中期和长期使用进行分层。现有长期使用者停药和开始新的长期使用的时间趋势以及对长期阿片类药物使用率的净影响。与上一年的使用模式相比，转向长期阿片类药物使用的相对可能性。阿片类药物处方的流行率为 20.8%，2010 年为 20.8%，2012 年达到峰值 21.2%，逐年下降至 2016 年的 16.1%。2010 年至 2016 年间，长期阿片类药物处方的减少占阿片类药物处方总体下降的 83%。阿片类药物处方满足。将 2010-2011 年的数据与 2015-2016 年的数据进行比较，发现 VHA 中阿片类药物长期使用流行率下降的 90% 以上是由新长期使用率下降造成的，而现有长期使用者戒烟率的增加所占比例不到 10%。相对于 2015 年期间未配阿片类药物处方的患者，2016 年期间短期使用者转向长期使用的相对风险为 6.5（95% CI：6.4、6.7），中间使用者为 35.5（95% CI：34.8、36.3）。阿片类药物处方趋势在 VHA 和非 VHA 环境中遵循相似的轨迹，峰值约为2012 年开始下降。然而，长期阿片类药物处方的变化是 VHA 下降的主要原因。最近 VA 的阿片类药物举措可能会阻止患者开始长期使用。这可能会提供可推广到其他医疗保健系统的宝贵经验教训。
Improved understanding of temporal trends in short- and long-term opioid prescribing may inform efforts to curb the opioid epidemic.To characterize the prevalence of short- and long-term opioid prescribing in the Veterans Health Administration (VHA) from 2010 to 2016.Observational cohort study using VHA databases.All patients receiving at least one outpatient prescription through the VHA during calendar years 2010 through 2016.Prevalence of opioid use from 2010 through 2016, stratified by short-term, intermediate-term, and long-term use. Temporal trends in discontinuation among existing long-term users and initiation of new long-term use and the net impact on rates of long-term opioid use. Relative likelihood of transitioning to long-term opioid use contrasted with use patterns in the prior year.The prevalence of opioid prescribing was 20.8% in 2010, peaked at 21.2% in 2012, and declined annually to 16.1% in 2016. Between 2010 and 2016, reductions in long-term opioid prescribing accounted for 83% of the overall decline in opioid prescription fills. Comparing data from 2010-2011 to data from 2015-2016, declining rates in new long-term use accounted for more than 90% of the decreasing prevalence of long-term opioid use in the VHA, whereas increases in cessation among existing long-term users accounted for less than 10%. The relative risk of transitioning to long-term use during 2016 was 6.5 (95% CI: 6.4, 6.7) among short-term users and 35.5 (95% CI: 34.8, 36.3) among intermediate users, relative to patients with no opioid prescriptions filled during 2015.Opioid prescribing trends followed similar trajectories in VHA and non-VHA settings, peaking around 2012 and subsequently declining. However, changes in long-term opioid prescribing accounted for most of the decline in the VHA. Recent VA opioid initiatives may be preventing patients from initiating long-term use. This may offer valuable lessons generalizable to other healthcare systems.