Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA.
Pain Med. 2014 Jan;15(1):73-8. doi: 10.1111/pme.12247. Epub 2013 Oct 9.
Opioid adverse events are widespread, and deaths have been directly attributed to opioids prescribed by medical professionals. Little information exists on the amount of opioids various medical specialties prescribe and the opioid fatality rate that would be expected if prescription opioid-related deaths were independent of medical specialty.
To compute the incidence of prescription opioid fatalities by medical specialty in Utah and to calculate the attributable risk (AR) of opioid fatality by medical specialty.
Prevalence database study design linking the Utah Controlled Substance Database (CSD) for prescribing data with the Utah Medical Examiner data to identify prescription opioid fatalities. AR were calculated for each medical specialty and year.
Opioid prescriptions are common with 23,302,892 recorded in the CSD for 2002-2010, 0.64% of which were associated with a fatality. We attached specialty to 90.2% of opioid prescriptions. Family medicine and internal medicine physicians wrote the largest proportion of prescriptions (24.1% and 10.8%) and were associated with the greatest number of prescription opioid fatalities. The number of active prescriptions at time of death decreased each year. The AR of fatality by provider specialty varied each year with some specialties, such as pain medicine and anesthesiology, consistently associated with more fatalities per 1,000 opioid prescriptions than internal medicine physicians the same year.
Primary care providers were the most frequent prescribers and the most often associated with opioid fatalities and should be targeted for education about safe prescribing along with specialties that prescribe less frequently but are associated with a positive AR for opioid fatality.
阿片类药物不良反应广泛存在，且有死亡病例被直接归因于专业医务人员开具的阿片类药物。关于各个医学专业开具的阿片类药物数量以及如果将处方类阿片类药物相关死亡病例与医学专业分开考虑，预计的阿片类药物死亡率，相关信息很少。
计算犹他州各医学专业的处方类阿片类药物死亡病例发生率，并计算各医学专业的阿片类药物死亡率归因风险（AR）。
采用流行数据库研究设计，将犹他州管制物质数据库（CSD）的处方数据与犹他州法医数据进行链接，以确定处方类阿片类药物死亡病例。计算了各医学专业和各年的 AR。
阿片类药物处方十分常见，在 2002 年至 2010 年的 CSD 中记录有 23302892 张，其中 0.64%与死亡有关。我们将专业信息与 90.2%的阿片类药物处方相关联。家庭医学和内科医生开具的处方比例最大（分别为 24.1%和 10.8%），与最多的处方类阿片类药物死亡病例有关。死亡时的有效处方数量逐年减少。每年各专业医生开具处方导致死亡的 AR 都有所不同，某些专业（如疼痛医学和麻醉学）始终与每 1000 张阿片类药物处方导致的更多死亡病例相关，而同年的内科医生则不然。
初级保健提供者是最常见的处方开具者，也是最常与阿片类药物死亡相关的人群，应针对他们开展安全处方开具教育，此外，还应针对那些开具处方频率较低但 AR 值为阿片类药物死亡呈阳性的专业开展教育。
