Intended and unintended consequences: Changes in opioid prescribing practices for postsurgical, acute, and chronic pain indications following two policies in North Carolina, 2012-2018-Controlled and single-series interrupted time series analyses
Intended and unintended consequences: Changes in opioid prescribing practices for postsurgical, acute, and chronic pain indications following two policies in North Carolina, 2012-2018-Controlled and single-series interrupted time series analyses
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DOI：
10.1016/j.drugalcdep.2022.109727
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发表时间：
2022-12-12
影响因子：
4.2
通讯作者：
Pence, Brian W.
中科院分区：
文献类型：
--
作者：
Maierhofer, Courtney N.;Ranapurwala, Shabbar I.;Pence, Brian W.
背景资料：目前阿片类药物处方政策的潜在误用仍未得到充分研究，可能对患者安全产生重大不利影响。我们使用自回归综合移动平均模型来评估每月1）处方率，2）日供应量，和3）每日吗啡毫克当量（MME）的事件阿片类药物处方相对于1）国家医疗委员会倡议，以减少高剂量和-阿片类药物处方量和2）立法限制用于急性和术后疼痛的初始阿片类药物处方。我们使用苯二氮卓类药物的处方模式来控制时间趋势，通过疼痛适应症和癌症病史来检查结局。我们使用大型私人医疗保险索赔数据，包括北卡罗来纳州居民，年龄18 - 64岁，在2012年1月至2018年8月期间的任何时间点投保。结果：在医疗委员会倡议后，慢性疼痛患者的处方模式没有改变;相反地，急性和术后疼痛患者的每日MME立即下降。急性、术后和非癌症疼痛患者的立法处方率没有下降，但慢性疼痛癌症患者的立法处方率却下降了。慢性疼痛患者经历了最大的天数供应下降立法后，而不是急性和术后疼痛patients.Conclusions：我们发现混合证据的潜在影响两个阿片类药物处方政策，与一些观察到的下降，在一组不打算受到政策的影响。这项研究提供了证据，表明需要更明确的阿片类药物处方政策，以确保对目标人群的影响，并避免意外后果。
Background: The potential misapplication of current opioid prescribing policies remains understudied and may have substantial adverse implications for patient safety.Methods: We used autoregressive integrated moving average models to assess level and trend changes in monthly 1) prescribing rates, 2) days' supply, and 3) daily morphine milligram equivalents (MME) of incident opioid prescriptions relative to 1) a state medical board initiative to reduce high-dose and-volume opioid prescribing and 2) legislation to limit initial opioid prescriptions for acute and postsurgical pain. We examined outcomes by pain indication overall and by cancer history, using prescribing patterns for benzodiazepines to control for temporal trends. We used large private health insurance claims data to include North Carolina residents, aged 18-64, insured at any point between January 2012 and August 2018.Results: After the medical board initiative, prescribing patterns for chronic pain patients did not change; conversely, acute and postsurgical pain patients experienced immediate declines in daily MME. Post-legislation prescription rates did not decline for those with acute, postsurgical, and non-cancer pain, but instead declined among cancer patients with chronic pain. Chronic pain patients experienced the largest days' supply declines post-legislation, instead of acute and postsurgical pain patients.Conclusions: We found mixed evidence on the potential impact of two opioid prescribing policies, with some observed declines in a group not intended to be impacted by the policy. This study provides evidence of the need for clearer opioid prescribing policies to ensure impacts on intended populations and avoid unintended consequences.