The Department of Emergency Medicine, The George Washington University, Washington, DC; The Department of Clinical Pharmacology, Children's National Medical Center, Washington, DC.
Acad Emerg Med. 2014 Mar;21(3):236-43. doi: 10.1111/acem.12328.
The objective was to describe trends in opioid and nonopioid analgesia prescribing for adults in U.S. emergency departments (EDs) over the past decade.
Data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) 2001 through 2010 were analyzed. ED visits for adult patients (≥18 years of age) during which an analgesic was prescribed were included. Trends in the use of six commonly prescribed opioids, stratified by Drug Enforcement Agency (DEA) schedule, as well as nonopioid analgesics were explored, along with the frequency of pain-related ED visits. For 2005 through 2010, data were further divided by whether the opioid was administered in the ED versus prescribed at discharge.
Between 2001 and 2010, the percentage of overall ED visits (pain-related and non-pain-related) where any opioid analgesic was prescribed increased from 20.8% to 31.0%, an absolute increase of 10.2% (95% confidence interval [CI] = 7.0% to 13.4%) and a relative increase of 49.0%. Use of DEA schedule II analgesics increased from 7.6% in 2001 to 14.5% in 2010, an absolute increase of 6.9% (95% CI = 5.2% to 8.5%) and a relative increase of 90.8%. Use of schedule III through V agents increased from 12.6% in 2001 to 15.6% in 2010, an absolute increase of 3.0% (95% CI = 2.0% to 5.7%) and a relative increase of 23.8%. Prescribing of hydrocodone, hydromorphone, morphine, and oxycodone all increased significantly, while codeine and meperidine use declined. Prescribing of nonopioid analgesics was unchanged, 26.2% in 2001 and 27.3% in 2010 (95% CI = -1.0% to 3.4%). Hydromorphone and oxycodone had the greatest increase in ED administration between 2005 and 2010, while oxycodone and hydrocodone had the greatest increases in discharge prescriptions. There was no difference in discharge prescriptions for nonopioid analgesics. The percentage of visits for painful conditions during the period increased from 47.1% in 2001 to 51.1% in 2010, an absolute increase of 4.0% (95% CI = 2.3% to 5.8%).
There has been a dramatic increase in prescribing of opioid analgesics in U.S. EDs in the past decade, coupled with a modest increase in pain-related complaints. Prescribing of nonopioid analgesics did not significantly change.
本研究旨在描述过去十年间美国急诊科（ED）开具阿片类药物和非阿片类药物处方的趋势。
分析了 2001 年至 2010 年国家医院门诊医疗调查（NHAMCS）的数据。纳入了为≥18 岁的成年患者开具镇痛药的 ED 就诊病例。研究了六种常用阿片类药物（按药物管制局（DEA）分类）的使用趋势，以及非阿片类镇痛药的使用趋势，同时还研究了与疼痛相关的 ED 就诊频率。对于 2005 年至 2010 年的数据，还进一步按阿片类药物是否在 ED 中给药或在出院时开具处方进行了细分。
2001 年至 2010 年间，总体 ED 就诊（疼痛相关和非疼痛相关）中开具任何阿片类镇痛药的比例从 20.8%增至 31.0%，绝对增加了 10.2%（95%置信区间[CI]：7.0%至 13.4%），相对增加了 49.0%。DEA 分类 II 类镇痛药的使用从 2001 年的 7.6%增加到 2010 年的 14.5%，绝对增加了 6.9%（95%CI：5.2%至 8.5%），相对增加了 90.8%。DEA 分类 III 至 V 类药物的使用从 2001 年的 12.6%增加到 2010 年的 15.6%，绝对增加了 3.0%（95%CI：2.0%至 5.7%），相对增加了 23.8%。氢可酮、氢吗啡酮、吗啡和羟考酮的处方量均显著增加，而可待因和哌替啶的使用量则下降。非阿片类镇痛药的处方量保持不变，2001 年为 26.2%，2010 年为 27.3%（95%CI：-1.0%至 3.4%）。在 2005 年至 2010 年期间，氢吗啡酮和羟考酮在 ED 给药中的增幅最大，而羟考酮和氢可酮在出院处方中的增幅最大。非阿片类镇痛药的出院处方没有差异。在此期间，疼痛相关疾病的就诊比例从 2001 年的 47.1%增加到 2010 年的 51.1%，绝对增加了 4.0%（95%CI：2.3%至 5.8%）。
过去十年间，美国 ED 开具阿片类药物处方的数量大幅增加，同时疼痛相关投诉也略有增加。非阿片类镇痛药的处方量没有显著变化。
