Opioid Prescribing in the United States Before and After the Centers for Disease Control and Prevention's 2016 Opioid Guideline
Opioid Prescribing in the United States Before and After the Centers for Disease Control and Prevention's 2016 Opioid Guideline
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DOI：
10.7326/m18-1243
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发表时间：
2018-09-18
影响因子：
39.2
通讯作者：
Losby, Jan L.
中科院分区：
文献类型：
--
作者：
Bohnert, Amy S. B.;Guy, Gery P., Jr.;Losby, Jan L.
背景资料：为了应对处方阿片类药物的不良后果，美国疾病控制和预防中心（CDC）于2016年3月发布了《慢性疼痛阿片类药物处方指南》。目的：检验CDC指南发布与特定阿片类药物处方实践下降相对应的假设。设计：对IQVIA交易数据仓库和真实世界数据纵向处方人群的每月处方指标进行中断时间序列分析-基于零售药店数据的水平估计。人口规模由美国人口普查月度估计确定。设置：美国，2012年至2017年。患者：处方阿片类镇痛药的人员。测量：结局包括阿片类药物剂量、供应天数、重叠苯二氮卓类药物处方和总体处方率。结果：高剂量处方率2012年1月，每10万人中有683人使用吗啡（每天>= 90毫克吗啡当量），（95% CI，-3.79至-3.32），之后为8.00（CI，-8.69至-7.31）。同样，2012年1月阿片类药物和苯二氮卓类药物处方重叠的患者百分比为21.04%，在CDC指南发布前每月下降0.02%（CI，-0.04%至-0.01%），之后每月下降0.08%（CI，-0.08%至-0.07%）。2012年1月，阿片类药物总体处方率为每10万人6577例，下降了23.48（CI，-26.18至-20.78）指南发布前每月和56.74（CI，-65.96至-47.53）。局限性：无对照人群;无法确定阿片类药物处方的适当性。在CDC指南发布之前，几种阿片类药物处方做法正在减少，但其发布时间与更大的下降有关。指南可能在改变处方实践方面有效。
Background: In response to adverse outcomes from prescription opioids, the Centers for Disease Control and Prevention (CDC) released the Guideline for Prescribing Opioids for Chronic Pain in March 2016.Objective: To test the hypothesis that the CDC guideline release corresponded to declines in specific opioid prescribing practices.Design: Interrupted time series analysis of monthly prescribing measures from the IQVIA transactional data warehouse and Real-World Data Longitudinal Prescriptions population-level estimates based on retail pharmacy data. Population size was determined by U.S. Census monthly estimates.Setting: United States, 2012 to 2017.Patients: Persons prescribed opioid analgesics.Measurements: Outcomes included opioid dosage, days supplied, overlapping benzodiazepine prescriptions, and the overall rate of prescribing.Results: The rate of high-dosage prescriptions (>= 90 morphine equivalent milligrams per day) was 683 per 100 000 persons in January 2012 and declined by 3.56 (95% CI, -3.79 to -3.32) per month before March 2016 and by 8.00 (CI, -8.69 to -7.31) afterward. Likewise, the percentage of patients with overlapping opioid and benzodiazepine prescriptions was 21.04% in January 2012 and declined by 0.02% (CI, -0.04% to -0.01%) per month before the CDC guideline release and by 0.08% (CI, -0.08% to -0.07%) per month afterward. The overall opioid prescribing rate was 6577 per 100 000 persons in January 2012 and declined by 23.48 (CI, -26.18 to -20.78) each month before the guideline release and by 56.74 (CI, -65.96 to -47.53) per month afterward.Limitation: No control population; inability to determine the appropriateness of opioid prescribing.Conclusion: Several opioid prescribing practices were decreasing before the CDC guideline, but the time of its release was associated with a greater decline. Guidelines may be effective in changing prescribing practices.