Groenewald Cornelius B, Rabbitts Jennifer A, Gebert J Thomas, Palermo Tonya M
Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, USA Department of Neurobiology, University of Washington College of Arts and Sciences and School of Medicine, Seattle, WA, USA Departments of Psychiatry, and Pediatrics, University of Washington School of Medicine, Seattle, WA, USA.
Pain. 2016 May;157(5):1021-1027. doi: 10.1097/j.pain.0000000000000475.
Prescription opioid misuse is a major public health concern in the United States, yet little is known about national prescription patterns. We aimed to assess trends in opioid prescriptions made to children and adolescents, to their families, and to adults in the United States from 1996 to 2012. The sample was drawn from nationally representative data, the Medical Expenditure Panel Surveys. We used survey design methods to examine trends in prescription opioid use over time and a logistic regression analysis to examine predictors associated with opioid use. Findings indicated that from 1996 to 2012 opioid prescriptions to children and adolescents remained stable and low. In 1996, 2.68% of children received an opioid prescription, and in 2012, 2.91% received an opioid prescription. In contrast, opioid prescriptions to family members of children and adolescents and adults in general significantly increased during this period. The most common opioid prescriptions to children and adolescents in 2012 were codeine, hydrocodone, and oxycodone. Using multivariate logistic regression models, the white non-Hispanic race, older age, health insurance, and parent-reported fair to poor general health were associated with higher rates of opioid prescriptions in children and adolescents. Our main finding was that although the rates of opioid prescriptions have increased among adults in the United States, the rates have not changed among children and adolescents. Recent epidemiologic association studies have identified a strong link between increased opioid prescriptions and increased rates of opioid misuse and abuse in adults. Future studies should assess the association between adult opioid prescriptions and children or adolescent opioid misuse.
在美国,处方阿片类药物滥用是一个重大的公共卫生问题,但对于全国的处方模式却知之甚少。我们旨在评估1996年至2012年期间美国给儿童、青少年及其家庭以及成年人开具阿片类药物处方的趋势。样本取自具有全国代表性的数据——医疗支出小组调查。我们使用调查设计方法来研究处方阿片类药物使用随时间的趋势,并使用逻辑回归分析来研究与阿片类药物使用相关的预测因素。研究结果表明,1996年至2012年期间,给儿童和青少年开具的阿片类药物处方保持稳定且数量较低。1996年,2.68%的儿童接受了阿片类药物处方,2012年,这一比例为2.91%。相比之下,在此期间给儿童和青少年的家庭成员以及一般成年人开具的阿片类药物处方显著增加。2012年给儿童和青少年最常用的阿片类药物处方是可待因、氢可酮和羟考酮。使用多变量逻辑回归模型,非西班牙裔白人种族、年龄较大、有医疗保险以及父母报告的一般健康状况为中等至较差与儿童和青少年中较高的阿片类药物处方率相关。我们的主要发现是,尽管美国成年人中的阿片类药物处方率有所上升,但儿童和青少年中的这一比率并未改变。最近的流行病学关联研究已经确定,成人中阿片类药物处方增加与阿片类药物滥用和误用率上升之间存在密切联系。未来的研究应该评估成人阿片类药物处方与儿童或青少年阿片类药物滥用之间的关联。