阿片类药物滥用和误用流行：对医院及医疗系统药剂师的影响

The opioid abuse and misuse epidemic: implications for pharmacists in hospitals and health systems.

作者信息

Cobaugh Daniel J, Gainor Carl, Gaston Cynthia L, Kwong Tai C, Magnani Barbarajean, McPherson Mary Lynn, Painter Jacob T, Krenzelok Edward P

机构信息

Daniel J. Cobaugh, Pharm.D., DABAT, FAACT, is Vice President, ASHP Research and Education Foundation, Bethesda, MD. Carl Gainor, J.D., Ph.D., is Clinical Assistant Professor of Pharmaceutical Sciences, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA. Cynthia L. Gaston, Pharm.D., BCPS, is Medication Use Policy Analyst, UW Health, Madison, WI. Tai C. Kwong, Ph.D., is Professor of Pathology and Laboratory Medicine, University of Rochester School of Medicine and Dentistry, and Director, Hematology and Chemistry Labs, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, NY. Barbarajean Magnani, Ph.D., M.D., is Chair and Pathologist-in-Chief, Department of Pathology and Laboratory Medicine, Tufts Medical Center, and Professor and Chair, Department of Anatomic and Clinical Pathology, Tufts University School of Medicine, Boston, MA. Mary Lynn McPherson, Pharm.D., BCPS, CPE, is Professor and Vice Chair, Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore. Jacob T. Painter, Pharm.D., M.B.A., Ph.D., is Assistant Professor of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock. Edward P. Krenzelok, Pharm.D., FAACT, FEAPCCT, DABAT, is Professor Emeritus, School of Pharmacy, University of Pittsburgh.

出版信息

Am J Health Syst Pharm. 2014 Sep 15;71(18):1539-54. doi: 10.2146/ajhp140157.

DOI:10.2146/ajhp140157

PMID:25174015

Abstract

PURPOSE

The current epidemic of prescription opioid abuse and misuse in the United States is discussed, with an emphasis on the pharmacist's role in ensuring safe and effective opioid use.

SUMMARY

U.S. sales of prescription opioids increased fourfold from 1999 to 2010, with an alarming rise in deaths and emergency department visits associated with the use of fentanyl, hydrocodone, oxycodone, and other opioid medications. Signs and symptoms of opioid toxicity may include altered mental status, hypoventilation, decreased bowel motility, central nervous system and respiratory depression, peripheral vasodilation, pulmonary edema, hypotension, bradycardia, and seizures. In patients receiving long-term opioid therapy for chronic pain, urine drug testing is an important tool for monitoring and assessment of therapy; knowledge of opioid metabolic pathways and assay limitations is essential for appropriate use and interpretation of screening and confirmatory tests. In recent years, there has been an increase in federal enforcement actions against pharmacies and prescription drug wholesalers involved in improper opioid distribution, as well as increased reliance on state-level prescription drug monitoring programs to track patterns of opioid use and improper sales. Pharmacies are urged to implement or promote appropriate guidelines on opioid therapy, including the use of pain management agreement plans; policies to ensure adequate oversight of opioid prescribing, dispensing, and waste disposal; and educational initiatives targeting patients as well as hospital and pharmacy staff.

CONCLUSION

Pharmacists in hospitals and health systems can play a key role in recognizing the various forms of opioid toxicity and in preventing inappropriate prescribing and diversion of opioids.

摘要

目的

讨论美国当前处方阿片类药物滥用和误用的流行情况，重点强调药剂师在确保阿片类药物安全有效使用方面的作用。

总结

从1999年到2010年，美国处方阿片类药物的销售额增长了四倍，与使用芬太尼、氢可酮、羟考酮及其他阿片类药物相关的死亡和急诊就诊人数惊人地增加。阿片类药物中毒的体征和症状可能包括精神状态改变、通气不足、肠蠕动减弱、中枢神经系统和呼吸抑制、外周血管扩张、肺水肿、低血压、心动过缓和癫痫发作。对于接受慢性疼痛长期阿片类药物治疗的患者，尿液药物检测是监测和评估治疗的重要工具；了解阿片类药物代谢途径和检测局限性对于筛查和确证试验的正确使用及解读至关重要。近年来，联邦政府加强了对涉及不当阿片类药物分销的药店和处方药批发商的执法行动，同时越来越依赖州级处方药监测计划来追踪阿片类药物使用模式和不当销售情况。敦促药店实施或推广阿片类药物治疗的适当指南，包括使用疼痛管理协议计划；确保对阿片类药物处方、配药和废物处理进行充分监督的政策；以及针对患者以及医院和药店工作人员的教育举措。