Opioid Prescribing Patterns in the U.S.

描述（由申请人提供）：在过去十年中，处方阿片类药物滥用已成为美国的主要公共卫生问题。近500万美国人积极使用这些药物用于非医疗目的，近100万人在身体上依赖它们，使疼痛药物成瘾在美国与可卡因成瘾一样常见。然而，令人担忧的是，过去10年来医生处方模式的变化可能是助长这一流行病的部分原因。 本研究的目的是了解医生处方模式如何变化， 在过去的十年中，最终目标是提高医生处方的质量和为公共政策提供信息。国家门诊医疗调查（NAMCS）和国家医院门诊医疗调查（NHAMCS）提供了一个独特的机会，通过每年提供大量全国代表性样本的广泛横断面数据，检查阿片类药物处方模式的变化，这些样本包括非联邦雇用的办公室医生（NAMCS）、医院门诊部（NHAMCS-OPD）和急诊科（NHAMCS-ED）。使用NAMCS/NHAMCS在1993-2002年调查期间收集的851，212例独特患者访视数据，我们计划分析： 在美国，每年有多少门诊护理导致阿片类药物处方？ 患者行为（表现为疼痛）和医生行为（处方疼痛）如何影响阿片类药物处方的趋势 镇痛药的选择如何随时间变化（非阿片类药物与阿片类药物、短效阿片类药物与长效阿片类药物、高滥用可能性和品牌制剂） 阿片类药物处方如何因临床环境、医生类型和地理区域/美国州而异 摘要和与公共卫生的相关性：止痛药成瘾是美国的一个主要公共卫生问题，在过去10年中显著增加。这项研究的目标是了解在这段时间内医生处方的变化，并为控制这些成瘾但必不可少的药物供应的医生和政策制定者如何减缓流行病产生想法。

DESCRIPTION (Provided by the Applicant): Prescription opioid abuse has emerged as a major public health problem in the U.S. during the last decade. Nearly five million Americans actively use these medications for non-medical purposes, and nearly one million are physically dependent on them, making pain medicine addiction as common as cocaine addiction in the U.S. This substance abuse epidemic is unique in that the "supply side" of the epidemic is controlled by physicians, who prescribe these addictive but often essential medications for treatment of pain. There is concern, however, that changes in physician prescribing patterns during the last 10 years may be partially responsible for fueling the epidemic. The objective of this research is to understand how physician prescribing patterns have changed during the last decade, with the ultimate goal of improving the quality of physician prescribing and informing public policy. The National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS) offer a unique opportunity to examine changing opioid prescribing patterns by providing extensive cross-sectional data every year on a large, nationally representative sample of all ambulatory care visits to non-federally-employed office-based physicians (NAMCS), hospital-based outpatient departments (NHAMCS-OPD), and emergency departments (NHAMCS-ED). Using NAMCS/NHAMCS data collected on 851,212 unique patient visits during survey years 1993-2002, we plan to analyze: How many ambulatory care visits result in an opioid prescription every year in the U.S. How patient behavior (presenting with pain) and physician behavior (prescribing for pain) contribute to trends in opioid prescribing How choice of analgesic has changed over time (non-opioids vs. opioids, short- vs. long-acting opioids, high abuse potential and brand name formulations) How opioid prescribing differs by clinical setting, physician type, and geographic area/U.S. state Summary and relevance to public health: Addiction to pain medications is a major public health problem in the U.S. that has increased markedly in the last 10 years. The goal of this research is to understand how physician prescribing has changed during this time period, and to generate ideas for how physicians and policymakers, who control the supply of these addictive but essential medications, can slow the epidemic.