From the *Departments of Anesthesiology, †Orthopaedic Surgery, ‡Communityand Family Medicine, Community Health Research Program, Hood Center for Children and Families; and §The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH.
Reg Anesth Pain Med. 2014 Jan-Feb;39(1):6-12. doi: 10.1097/AAP.0000000000000022.
In the United States, use of oral opioid analgesics has been associated with increasing rates of addiction, abuse, and diversion. However, little is known about the recent national use of non-illicit prescription opioid analgesics (those prescribed in a physician-patient relationship), the primary source of these drugs for the general US population. Our primary objective was to examine trends in the use of prescription opioid analgesics in the United States and to identify defining characteristics of patient users of prescribed opioids from 2000 to 2010.
We used the nationally representative Medical Expenditure Panel Survey to examine trends in prescription oral opioid analgesic use from 2000 to 2010. We used survey design methods to make national estimates of adults (18 years and older) who reported receiving an opioid analgesic prescription (referred to as opioid users) and used logistic regression to examine predictors of opioid analgesic use. Our primary outcome measures were national estimates of total users of prescription opioid analgesics and total number of prescriptions. Our secondary outcome was that of observing changes in the disability and health of the users.
The estimated total number of opioid analgesic prescriptions in the United States increased by 104%, from 43.8 million in 2000 to 89.2 million in 2010. In 2000, an estimated 7.4% (95% confidence interval, 6.9-7.9) of adult Americans were prescription opioid users compared with 11.8% (95% confidence interval, 11.2-12.4) in 2010. On the basis of estimates adjusted for changes in the general population, each year was associated with a 6% increase in the likelihood of receiving an opioid prescription from 2000 to 2010. Despite the apparent increase in use, there were no demonstrable improvements in the age- or sex-adjusted disability and health status measures of opioid users.
The use of prescription opioid analgesics among adult Americans has increased in recent years, and this increase does not seem to be associated with improvements in disability and health status among users. On a public health level, these data suggest that there may be an opportunity to reduce the prescribing of opioid analgesics without worsening of population health metrics.
在美国，口服阿片类镇痛药的使用与成瘾、滥用和转移的发生率不断增加有关。然而，对于非非法处方类阿片类镇痛药（即医生与患者之间开具的处方）的近期全国使用情况，以及这些药物在普通美国人群中的主要来源，人们知之甚少。我们的主要目的是研究美国处方类阿片类镇痛药使用趋势，并确定 2000 年至 2010 年期间患者使用处方阿片类药物的特征。
我们使用全国代表性的医疗支出面板调查，研究 2000 年至 2010 年期间处方口服阿片类镇痛药的使用趋势。我们使用调查设计方法对报告接受阿片类镇痛药处方的成年人（18 岁及以上）（称为阿片类药物使用者）进行全国估计，并使用逻辑回归检查阿片类镇痛药使用的预测因素。我们的主要结局指标是全国范围内处方类阿片类镇痛药使用者的总数和处方总数。我们的次要结局是观察使用者的残疾和健康状况的变化。
美国估计的阿片类镇痛药处方总数增加了 104%，从 2000 年的 4380 万增加到 2010 年的 8920 万。2000 年，约有 7.4%（95%置信区间，6.9-7.9）的美国成年人是处方阿片类药物使用者，而 2010 年这一比例为 11.8%（95%置信区间，11.2-12.4）。基于对总人口变化进行调整的估计，与 2000 年相比，2010 年每年接受阿片类药物处方的可能性增加 6%。尽管使用量明显增加，但阿片类药物使用者的年龄或性别调整后的残疾和健康状况指标并没有明显改善。
近年来，美国成年人使用处方类阿片类镇痛药的情况有所增加，而这种增加似乎与使用者的残疾和健康状况改善无关。从公共卫生的角度来看，这些数据表明，在不恶化人口健康指标的情况下，可能有机会减少阿片类镇痛药的处方。
