Opioid Prescribing Patterns in the U.S.

描述(由申请人提供)：在过去的十年里，处方阿片类药物滥用已经成为美国一个主要的公共卫生问题。近500万美国人积极地将这些药物用于非医疗目的，近100万人在身体上依赖这些药物，这使得止痛药成瘾在美国与可卡因成瘾一样普遍。这种药物滥用流行病的独特之处在于，这种流行病的“供应方”由医生控制，医生开出这些令人上瘾但往往是治疗疼痛的基本药物。然而，人们担心，在过去10年里，医生处方模式的变化可能是助长疫情的部分原因。 这项研究的目的是了解医生的处方模式在过去几年中是如何变化的 在过去的十年中，以提高医生开处方和为公共政策提供信息的质量为最终目标。全国门诊医疗调查(NAMCS)和国家医院门诊医疗调查(NHAMCS)提供了一个独特的机会，通过每年提供具有全国代表性的大样本阿片类药物处方模式变化的横断面数据，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在调查年度1993-2002年间收集的851,212次独特患者就诊数据，我们计划分析： 在美国，每年有多少次门诊护理导致开出阿片类药物处方。 患者行为(表现为疼痛)和医生行为(开出止痛药)如何促成阿片类药物处方的趋势 止痛药的选择随着时间的推移发生了怎样的变化(非阿片类药物与阿片类药物、短效与长效阿片类药物、高滥用潜力和品牌配方) 阿片类药物处方如何因临床环境、医生类型和地理区域/美国州而有所不同 摘要和与公共健康的相关性：在美国，止痛药成瘾是一个主要的公共健康问题，在过去10年中显著增加。这项研究的目标是了解医生处方在这段时间内发生了怎样的变化，并产生关于控制这些令人上瘾但必不可少的药物供应的医生和政策制定者如何减缓疫情的想法。

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.