Levy Benjamin, Paulozzi Leonard, Mack Karin A, Jones Christopher M
Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, CDC, Atlanta, Georgia.
Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, CDC, Atlanta, Georgia.
Am J Prev Med. 2015 Sep;49(3):409-13. doi: 10.1016/j.amepre.2015.02.020. Epub 2015 Apr 18.
Opioid analgesic prescriptions are driving trends in drug overdoses, but little is known about prescribing patterns among medical specialties. We conducted this study to examine the opioid-prescribing patterns of the medical specialties over time.
IMS Health's National Prescription Audit (NPA) estimated the annual counts of pharmaceutical prescriptions dispensed in the U.S. during 2007-2012. We grouped NPA prescriber specialty data by practice type for ease of analysis, and measured the distribution of total prescriptions and opioid prescriptions by specialty. We calculated the percentage of all prescriptions dispensed that were opioids, and evaluated changes in that rate by specialty during 2007-2012. The analysis was conducted in 2013.
In 2012, U.S. pharmacies and long-term care facilities dispensed 4.2 billion prescriptions, 289 million (6.8%) of which were opioids. Primary care specialties accounted for nearly half of all dispensed opioid prescriptions. The rate of opioid prescribing was highest for specialists in pain medicine (48.6%); surgery (36.5%); and physical medicine/rehabilitation (35.5%). The rate of opioid prescribing rose during 2007-2010 but leveled thereafter as most specialties reduced opioid use. The greatest percentage increase in opioid-prescribing rates during 2007-2012 occurred among physical medicine/rehabilitation specialists (+12.0%). The largest percentage drops in opioid-prescribing rates occurred in emergency medicine (-8.9%) and dentistry (-5.7%).
The data indicate diverging trends in opioid prescribing among medical specialties in the U.S. during 2007-2012. Engaging the medical specialties individually is critical for continued improvement in the safe and effective treatment of pain.
阿片类镇痛药的处方正在推动药物过量使用的趋势，但对于各医学专科的处方模式知之甚少。我们开展这项研究以考察各医学专科随时间推移的阿片类药物处方模式。
艾美仕市场研究公司的全国处方审计（NPA）估算了2007 - 2012年美国发放的药品处方的年度数量。为便于分析，我们按执业类型对NPA开处方者的专科数据进行了分组，并按专科测量了总处方数和阿片类药物处方数的分布情况。我们计算了所有发放处方中阿片类药物的百分比，并评估了2007 - 2012年期间各专科该比例的变化情况。该分析于2013年进行。
2012年，美国药店和长期护理机构发放了42亿张处方，其中2.89亿张（6.8%）为阿片类药物。初级保健专科占所有发放的阿片类药物处方的近一半。疼痛医学专科医生（48.6%）、外科医生（36.5%）以及物理医学/康复专科医生（35.5%）的阿片类药物处方率最高。2007 - 2010年期间阿片类药物处方率上升，但此后随着大多数专科减少阿片类药物使用而趋于平稳。2007 - 2012年期间阿片类药物处方率增幅最大的是物理医学/康复专科医生（+12.0%）。阿片类药物处方率降幅最大的是急诊医学（-8.9%）和牙科（-5.7%）。
数据表明2007 - 2012年期间美国各医学专科在阿片类药物处方方面呈现出不同趋势。针对各医学专科采取措施对于持续改善疼痛的安全有效治疗至关重要。
