Assessing Opioid Shopping Behaviour A Large Cohort Study from a Medication Dispensing Database in the US
Assessing Opioid Shopping Behaviour A Large Cohort Study from a Medication Dispensing Database in the US
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DOI：
10.2165/11596600-000000000-00000
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发表时间：
2012-01-01
期刊：
影响因子：
4.2
通讯作者：
Henderson, Scott C.
中科院分区：
文献类型：
--
作者：
Cepeda, M. Soledad;Fife, Daniel;Henderson, Scott C.
背景：滥用、误用和转移阿片类药物的风险令人担忧。从多个处方医生那里获得阿片类药物处方，即所谓的阿片类药物购买，是阿片类药物可能被滥用和转移的一种方式。以前的研究依赖于计算受试者一年内去过的处方医生或药店的数量来定义购物行为，但没有区分连续开处方的人和伴随的处方人。目的：该研究的目的是评估不同处方的阿片类药物重叠处方的频率，将其与利尿剂和苯二氮卓类药物进行比较，并提供购物行为的定义，区分阿片类药物和利尿剂，避免对合法使用阿片类药物的个人进行不适当的标记。研究设计：使用IMS LRx数据库进行基于人群的队列研究。这个数据库涵盖了美国65%的零售处方，包括邮寄服务和专业药房提供商的处方，与支付方式无关。地点：急救室。患者：2008年至少有一次任何类型阿片类药物的处方。类似的队列也被建立在暴露于苯二氮卓类或利尿剂的受试者身上。结果：共纳入25 161 024名阿片类药物接触者，其中13.1%的受试者在18个月的随访期内至少出现过1次重叠处方。接近10%的服用苯二氮卓类药物的受试者和13.8%的服用利尿剂的受试者表现出类似的行为。由三家或三家以上药店开出重叠的处方，将阿片类药物与其他药物类别区分开来。使用这一标准，在接触阿片类药物的受试者中，总体购物行为的风险为0.18%，在接触苯二氮卓类药物的受试者中，总体购物行为的风险为0.10%，在接触利尿剂的受试者中，总体购物行为的风险为0.03%。对于阿片类药物，年龄在25岁至之间的受试者表现出购物行为的比例(0.25%)高于65岁或65岁以上的受试者(0.07%)，有阿片类药物使用史的受试者表现出这种行为的比例(0.7%)高于阿片类药物未服用者的(0.07%)。结论：处方重叠并不是阿片类药物独有的，因此需要一个纳入药店数量的标准来定义购物行为。有两张或两张以上的重叠处方由不同的处方医生开出，并在三家或三家以上的药店配药，这将区分阿片类药物和利尿剂，并可能构成购物行为。
Background: Risks of abuse, misuse and diversion of opioids are of concern. Obtaining opioid prescriptions from multiple prescribers, known as opioid shopping, is a way in which opioids may be abused and diverted. Previous studies relied on counting the number of prescribers or number of pharmacies a subject goes to in a year to define shopping behaviour, but did not distinguish successive prescribers from concomitant prescribers.Objective: The aim of the study was to assess the frequency of opioid overlapping prescriptions from different prescribers, compare it with diuretics and benzodiazepines, and provide a definition of shopping behaviour that differentiates opioids from diuretics, avoiding the inappropriate flagging of individuals with legitimate use of opioids.Study Design: Population-based cohort study using the IMS LRx database. This database covers 65% of all retail prescriptions in the US and includes mail service and specialty pharmacy provider prescriptions independent of the method of payment.Setting: Ambulatory.Patients: Subjects with at least one dispensing for any type of opioid in 2008. Similar cohorts were created for subjects exposed to benzodiazepines or diuretics. Analyses were performed separately for naive subjects and those with prior use.Outcome: Frequency of overlapping prescriptions defined as at least 1 day of overlapping dispensing of prescriptions written by two or more different prescribers at any time during an 18-month period.Results: A total of 25 161 024 subjects exposed to opioids were included, of whom 13.1% exhibited at least one episode of overlapping prescriptions during 18 months of follow-up. Almost 10% of subjects exposed to benzodiazepines and 13.8% of subjects exposed to diuretics exhibited a similar behaviour. Having overlapping prescriptions dispensed by three or more pharmacies differentiates opioids from the other medication classes. Using that criterion, the overall risk of shopping behaviour was 0.18% in subjects exposed to opioids, 0.10% in subjects exposed to benzodiazepines and 0.03% in subjects exposed to diuretics. For opioids, subjects aged between 25 and 64 years exhibited shopping behaviour more commonly (0.25%) than subjects 65 years or older (0.07%), and subjects with a history of prior opioid use exhibited such behaviour more commonly (0.7%) than opioid-naive subjects (0.07%).Conclusion: Overlapping of prescriptions is not unique to opioids and therefore a criterion that incorporates number of pharmacies is needed to define shopping behaviour. Having two or more overlapping prescriptions written by different prescribers and filled at three or more pharmacies differentiates opioids from diuretics and likely constitutes shopping behaviour.