Nosyk Bohdan, Fischer Benedikt, Sun Huiying, Marsh David C, Kerr Thomas, Rehm Juergen T, Anis Aslam H
BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.
Am J Addict. 2014 May-Jun;23(3):257-64. doi: 10.1111/j.1521-0391.2014.12091.x.
The non-medical use of prescription opioids (PO) has increased dramatically in North America. Special consideration for PO prescription is required for individuals in methadone maintenance treatment (MMT). Our objective is to describe the prevalence and correlates of PO use among British Columbia (BC) MMT clients from 1996 to 2007.
This study was based on a linked, population-level medication dispensation database. All individuals receiving 30 days of continuous MMT for opioid dependence were included in the study. Key measurements included the proportion of clients receiving >7 days of a PO other than methadone during MMT from 1996 to 2007. Factors independently associated with PO co-prescription during MMT were assessed using generalized linear mixed effects regression.
16,248 individuals with 27,919 MMT episodes at least 30 days in duration were identified for the study period. Among them, 5,552 individuals (34.2%) received a total of 290,543 PO co-prescriptions during MMT. The majority (74.3%) of all PO dispensations >7 days originated from non-MMT physicians. The number of PO prescriptions per person-year nearly doubled between 1996 and 2006, driven by increases in morphine, hydromorphone and oxycodone dispensations. PO co-prescription was positively associated with female gender, older age, higher levels of medical co-morbidity as well as higher MMT dosage, adherence, and retention.
A large proportion of MMT clients in BC received co-occurring PO prescriptions, often from physicians and pharmacies not delivering MMT. Experimental evidence for the treatment of pain in MMT clients is required to guide clinical practice.
北美地区处方阿片类药物（PO）的非医疗用途急剧增加。对于接受美沙酮维持治疗（MMT）的个体，需要对PO处方进行特殊考虑。我们的目的是描述1996年至2007年不列颠哥伦比亚省（BC）MMT患者中PO使用的患病率及其相关因素。
本研究基于一个关联的、人群水平的药物配给数据库。所有因阿片类药物依赖接受30天连续MMT的个体均纳入研究。关键测量指标包括1996年至2007年期间MMT期间接受美沙酮以外的PO超过7天的患者比例。使用广义线性混合效应回归评估与MMT期间PO联合处方独立相关的因素。
在研究期间，共识别出16248名个体，发生了27919次持续至少30天的MMT发作。其中，5552名个体（34.2%）在MMT期间共接受了290543次PO联合处方。所有超过7天的PO配给中，大部分（74.3%）来自非MMT医生。由于吗啡、氢吗啡酮和羟考酮配给量的增加，1996年至2006年期间人均PO处方数量几乎翻了一番。PO联合处方与女性性别、年龄较大、更高的医疗合并症水平以及更高的MMT剂量、依从性和留存率呈正相关。
BC省很大一部分MMT患者同时接受了PO处方，这些处方通常来自不提供MMT的医生和药店。需要MMT患者疼痛治疗的实验证据来指导临床实践。
