华盛顿州医疗补助计划中的阿片类药物中毒：趋势、剂量及指南

Opioid poisonings in Washington State Medicaid: trends, dosing, and guidelines.

作者信息

Fulton-Kehoe Deborah, Sullivan Mark D, Turner Judith A, Garg Renu K, Bauer Amy M, Wickizer Thomas M, Franklin Gary M

机构信息

*Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health †Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine ‡Department of Epidemiology, University of Washington School of Public Health, Seattle, WA §Division of Health Services Management and Policy, College of Public Health, Ohio State University, Columbus, OH ∥Department of Health Services, University of Washington School of Public Health and Community Medicine ¶Washington State Department of Labor and Industries #Department of Neurology, University of Washington School of Medicine, Seattle, WA.

出版信息

Med Care. 2015 Aug;53(8):679-85. doi: 10.1097/MLR.0000000000000384.

DOI:10.1097/MLR.0000000000000384

PMID:26172937

Abstract

BACKGROUND

Opioid poisonings have increased as use of prescription opioid medications have increased. To reduce these poisonings, guidelines for chronic opioid use have been implemented. However, if opioid poisonings occur in individuals who do not have high prescribed doses and who are not chronic opioid users, the current guidelines may need revision.

OBJECTIVES

To examine changes in rates of methadone and other opioid poisonings after implementation of the WA State Opioid Guideline in 2007 and to examine the prescription history before poisonings.

METHODS

The study sample consisted of individuals who had at least 1 paid claim for an opioid prescription in the Medicaid fee-for-service system between April 2006 and December 2010 and had an emergency department or inpatient hospital claim for an opioid poisoning.

RESULTS

Methadone poisonings occurred at 10 times the rate of other prescription opioid poisonings and increased between 2006 and 2010. Rates of other prescription opioid poisonings appeared to level off after implementation of the WA opioid guideline in 2007. Among individuals with nonmethadone opioid poisonings, only 44% had chronic opioid use, 17% had prescribed doses in the week before the poisoning >120 mg/d morphine-equivalent dose (MED), 28% had doses <50 mg/d MED, and 48% had concurrent sedative prescriptions.

CONCLUSIONS

It may be prudent to revise guidelines to address opioid poisonings occurring at relatively low prescribed doses and with acute and intermittent opioid use. Research is needed to establish the best strategies to prevent opioid poisonings.

摘要

背景

随着处方阿片类药物使用的增加，阿片类药物中毒事件也有所上升。为减少此类中毒事件，已实施了慢性阿片类药物使用指南。然而，如果阿片类药物中毒发生在未开具高剂量处方且非慢性阿片类药物使用者的个体中，当前指南可能需要修订。

目的

研究2007年华盛顿州阿片类药物指南实施后美沙酮及其他阿片类药物中毒发生率的变化，并调查中毒前的处方用药史。

方法

研究样本包括2006年4月至2010年12月期间在医疗补助按服务收费系统中至少有1次阿片类药物处方付费索赔记录，且有急诊科或住院部阿片类药物中毒索赔记录的个体。

结果

美沙酮中毒发生率是其他处方阿片类药物中毒发生率的10倍，且在2006年至2010年间有所上升。2007年华盛顿州阿片类药物指南实施后，其他处方阿片类药物中毒发生率似乎趋于平稳。在非美沙酮阿片类药物中毒个体中，只有44%为慢性阿片类药物使用者，17%在中毒前一周开具的剂量>120mg/d吗啡当量剂量（MED），28%的剂量<50mg/d MED，48%同时开具了镇静剂处方。