Le Lait Marie-Claire, Martinez Erin M, Severtson Stevan G, Lavery Sarah A, Bucher-Bartelson Becki, Dart Richard C
Denver Health and Hospital Authority/Rocky Mountain Poison and Drug Center, USA.
Pharmacoepidemiol Drug Saf. 2014 Dec;23(12):1334-7. doi: 10.1002/pds.3653. Epub 2014 Jun 4.
Prescription opioid abuse and misuse are a serious problem in the U.S. today. Several studies have shown that the epidemic disproportionately affects rural areas. This paper uses three different rates to gain a more complete picture of opioid abuse in rural areas.
This study examines prescription opioid intentional exposures using opioid classes tracked in the RADARS(®) System Poison Center Program. Intentional exposure rates were calculated adjusting for population and unique recipients of dispensed drug (URDD). These rates were analyzed using time (quarter) and the proportion of a three-digit zip code residing in a rural area as covariates. Additionally, the URDD per population rate was calculated to examine the proportion of the population filling prescriptions for opioids.
After adjusting for population, intentional exposure cases significantly increased as the proportion of the population residing in a rural area increased. However, when adjusting for URDD, intentional exposure cases decreased with increasing rural population. The URDD per population increased as the proportion of people residing in a rural area increased.
Using both population and URDD adjusted intentional exposure rates gives a more complete picture of opioid abuse in rural areas. Considering product availability can be used to develop opioid abuse prevention strategies and further the education of physicians serving rural areas about this epidemic.
处方阿片类药物的滥用和误用在当今美国是一个严重问题。多项研究表明，这一流行现象对农村地区的影响尤为严重。本文采用三种不同比率，以更全面地了解农村地区的阿片类药物滥用情况。
本研究利用RADARS(®)系统中毒控制中心项目所追踪的阿片类药物类别，对处方阿片类药物的故意暴露情况进行研究。故意暴露率的计算对人口和配发药物的唯一接受者（URDD）进行了调整。这些比率以时间（季度）和居住在农村地区的三位邮政编码区域所占比例作为协变量进行分析。此外，还计算了人均URDD率，以研究开具阿片类药物处方的人口比例。
在对人口进行调整后，故意暴露病例随着农村地区人口比例的增加而显著增加。然而，在对URDD进行调整后，故意暴露病例随着农村人口的增加而减少。人均URDD随着农村地区人口比例的增加而上升。
使用经人口和URDD调整的故意暴露率，能更全面地了解农村地区的阿片类药物滥用情况。考虑到产品可得性，可用于制定阿片类药物滥用预防策略，并进一步对服务于农村地区的医生开展关于这一流行病的教育。
