DeVeaugh-Geiss Angela, Kadakia Aditi, Chilcoat Howard, Alexander Louis, Coplan Paul
Purdue Pharma LP, Stamford, Connecticut.
Purdue Pharma LP, Stamford, Connecticut.
J Pain. 2015 Jun;16(6):569-79.e1. doi: 10.1016/j.jpain.2015.03.004. Epub 2015 Mar 28.
Immediate-release (IR) hydrocodone/acetaminophen is the most prescribed opioid in the United States; however, patterns of use, including long-term treatment and dose, are not well described. Duration of use, including the percentage of patients on long-term treatment (>90 days of continuous use), was assessed for patients newly prescribed IR hydrocodone/acetaminophen compared to other opioid analgesics in a national commercial insurance database (January 2008-September 2013). Though only a small percentage of IR hydrocodone/acetaminophen patients continued treatment long-term (1.7%), the number was large (104,839) and was nearly 5 times the number receiving extended-release (ER) morphine (n = 22,338) and nearly 4 times the number receiving ER oxycodone (n = 26,946) long-term. Using a less conservative allowable gap in treatment increased the number of patients meeting the criteria for long-term use (approximately 160,000 for IR hydrocodone/acetaminophen vs <30,000 for ER morphine and ER oxycodone). Most patients meeting these criteria received IR hydrocodone doses between >20 and ≤60 mg/d (n = 56,220, 53.6%) in month 4; 5.5% (n = 5,743) received doses >60 mg/d. Moreover, approximately 15% of IR hydrocodone/acetaminophen patients (n > 900,000) were prescribed total daily acetaminophen doses exceeding 4 g (the limit recommended by the U.S. Food and Drug Administration) at their initial IR hydrocodone/acetaminophen prescription or any time during therapy.
Although most patients were prescribed IR hydrocodone/acetaminophen for acute pain, the number of patients prescribed long-term therapy exceeds the number of patients prescribed ER opioids. It is important to consider the benefits and risks inherent with long-term opioid therapy, whether with IR or ER opioids, to ensure safe use of these products.
速释型氢可酮/对乙酰氨基酚是美国处方量最大的阿片类药物；然而，其使用模式，包括长期治疗和剂量等情况，尚无详尽描述。在一个全国性商业保险数据库（2008年1月至2013年9月）中，对新开具速释型氢可酮/对乙酰氨基酚处方的患者与其他阿片类镇痛药使用者的用药时长进行了评估，其中用药时长包括长期治疗患者（连续使用超过90天）的比例。尽管只有一小部分速释型氢可酮/对乙酰氨基酚患者长期持续治疗（1.7%），但人数众多（104,839人），几乎是长期使用缓释吗啡患者人数（22,338人）的5倍，以及长期使用缓释羟考酮患者人数（26,946人）的近4倍。采用不那么保守的治疗允许间隔会增加符合长期使用标准的患者人数（速释型氢可酮/对乙酰氨基酚约为160,000人，而缓释吗啡和缓释羟考酮则少于30,000人）。多数符合这些标准的患者在第4个月时接受的速释型氢可酮剂量在>20至≤60毫克/天之间（56,220人，占53.6%）；5.5%（5,743人）接受的剂量>60毫克/天。此外，约15%的速释型氢可酮/对乙酰氨基酚患者（超过900,000人）在首次开具速释型氢可酮/对乙酰氨基酚处方时或治疗期间的任何时候，被开具的对乙酰氨基酚每日总剂量超过4克（美国食品药品监督管理局推荐的限量）。
尽管大多数患者因急性疼痛而开具速释型氢可酮/对乙酰氨基酚，但接受长期治疗的患者人数超过了接受缓释阿片类药物治疗的患者人数。重要的是要考虑长期阿片类药物治疗所固有的益处和风险，无论是使用速释型还是缓释型阿片类药物，以确保安全使用这些产品。
