Fischer Benedikt, Jones Wayne, Rehm Jürgen
Centre for Applied Research in Mental Health and Addiction (CARMHA), Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada.
BMC Health Serv Res. 2014 Feb 26;14:90. doi: 10.1186/1472-6963-14-90.
Prescription opioid analgesic (POA) utilization has steeply increased globally, yet is far higher in established market economies than elsewhere. Canada features the world's second-highest POA consumption rates. Following increases in POA-related harm, several POA control interventions have been implemented since 2010.
We examined trends and patterns in POA dispensing in Canada by province for 2005-2012, including a focus on the potential effects of interventions. Data on annual dispensing of individual POA formulations--categorized into 'weak opioids' and 'strong opioids'--from a representative sub-sample of 5,700 retail pharmacies across Canada (from IMS Brogan's Compuscript) were converted into Defined Daily Doses (DDD), and examined intra- and inter-provincially as well as for Canada (total).
Total POA dispensing--driven by strong opioids--increased across Canada until 2011; four provinces indicated decreases in strong opioid dispensing; seven provinces indicated decreases specifically in oxycodone dispensing, 2011-2012. The dispensing ratio weak/strong opioids decreased substantively. Major inter-provincial differences in POA dispensing levels and qualitative patterns of POA formulations dispensed persisted. Previous increasing trends in POA dispensing were reversed in select provinces 2011-2012, coinciding with POA-related interventions.
Further examinations regarding the sustained nature, drivers and consequences of the recent trend changes in POA dispensing--including possible 'substitution effects' for oxycodone reductions--are needed.
处方阿片类镇痛药（POA）的使用在全球范围内急剧增加，但在发达市场经济体中的使用率远高于其他地区。加拿大的POA消费率位居世界第二。自2010年以来，随着与POA相关的危害增加，已实施了多项POA控制干预措施。
我们研究了2005 - 2012年加拿大各省POA配药的趋势和模式，重点关注干预措施的潜在影响。从加拿大5700家零售药店的代表性子样本（来自IMS Brogan的Compuscript）中获取的关于个体POA制剂年度配药的数据 - 分为“弱阿片类药物”和“强阿片类药物” - 被转换为限定日剂量（DDD），并在省内和省际以及加拿大（总计）范围内进行了研究。
在2011年之前，加拿大的POA总配药量（由强阿片类药物推动）一直在增加；四个省份的强阿片类药物配药量有所下降；七个省份在2011 - 2012年期间，羟考酮配药量尤其下降。弱/强阿片类药物的配药比例大幅下降。POA配药水平和所配POA制剂的定性模式在省际之间仍存在重大差异。2011 - 2012年，部分省份之前的POA配药增长趋势发生逆转，这与POA相关干预措施同时出现。
需要进一步研究POA配药近期趋势变化的持续性、驱动因素和后果 - 包括羟考酮减少可能产生的“替代效应”。
