Chenaf Chouki, Kabore Jean-Luc, Delorme Jessica, Pereira Bruno, Mulliez Aurélien, Roche Lucie, Eschalier Alain, Delage Noémie, Authier Nicolas
INSERM, UMR 1107 NEURO-DOL, Faculté de Médecine, Université d'Auvergne, Clermont-Ferrand, France.
CHU Clermont-Ferrand, Centres Addictovigilance et Pharmacovigilance Auvergne (CEIP-CRPV), Service de Pharmacologie Médicale, Clermont-Ferrand, France.
Pharmacoepidemiol Drug Saf. 2016 Sep;25(9):1088-98. doi: 10.1002/pds.4056. Epub 2016 Jun 30.
Opioid analgesic use in chronic non-cancer pain (CNCP) is increasingly prevalent, but the benefits and risks are inadequately understood. In France, tramadol is one of the most used prescription opioids, but studies on its misuse liability in CNCP are still lacking. The aim was to assess the incidence of tramadol shopping behavior in CNCP patients and to identify the associated risk factors.
A retrospective cohort of CNCP patients aged 18 years and older treated by tramadol for at least six consecutive months between 2005 and 2013 from a sample of the French Health Insurance database was established. Doctor shopping was defined as at least 1 day of overlapping prescriptions written by two or more different prescribers and filled in at least three different pharmacies.
A total of 3505 CNCP patients were included with a majority of women (66.4%) and a mean age of 66.4 ± 14.7 years. The median tramadol treatment duration was 260 [interquartile range: 211-356] days. The 1-year incidence rate of tramadol shopping behavior was 1.0% [95%CI: 0.7-1.5]. On multivariate analysis, risk factors associated with tramadol shopping behavior were age (hazard ratio [HR] = 7.4 [95%CI: 2.8-19.7] for age <40, HR = 2.8 [95%CI: 1.0-7.7] for 40 ≤ age < 50, versus age ≥50), low-income status (HR = 8.5 [95%CI: 3.6-20.5]), and prior use of strong opioids (HR = 5.7 [95%CI: 1.9-17.0]).
Tramadol shopping behavior incidence appears low in CNCP patients but may represent a public health concern given the widespread use of tramadol. Education and best monitoring of high-risk patients are needed to reduce doctor shopping. Copyright © 2016 John Wiley & Sons, Ltd.
阿片类镇痛药在慢性非癌性疼痛（CNCP）中的使用日益普遍，但对其益处和风险的了解尚不充分。在法国，曲马多是最常用的处方阿片类药物之一，但关于其在CNCP中滥用倾向的研究仍很缺乏。本研究旨在评估CNCP患者中曲马多“购药行为”的发生率，并确定相关风险因素。
建立一个回顾性队列，纳入2005年至2013年间从法国医疗保险数据库样本中选取的、年龄在18岁及以上且接受曲马多治疗至少连续6个月的CNCP患者。“医生购药行为”定义为由两名或更多不同开方者开具的至少1天重叠处方，并在至少三家不同药店配药。
共纳入3505例CNCP患者，其中大多数为女性（66.4%），平均年龄为66.4±14.7岁。曲马多治疗的中位持续时间为260[四分位间距：211 - 356]天。曲马多购药行为的1年发生率为1.0%[95%置信区间：0.7 - 1.5]。多因素分析显示，与曲马多购药行为相关的风险因素包括年龄（年龄<40岁时，风险比[HR]=7.4[95%置信区间：2.8 - 19.7]；40≤年龄<50岁时，HR = 2.8[95%置信区间：1.0 - 7.7]，与年龄≥50岁相比）、低收入状态（HR = 8.5[95%置信区间：3.6 - 20.5]）以及既往使用过强效阿片类药物（HR = 5.7[95%置信区间：1.9 - 17.0]）。
CNCP患者中曲马多购药行为的发生率似乎较低，但鉴于曲马多的广泛使用，这可能代表一个公共卫生问题。需要对高危患者进行教育和加强监测，以减少“医生购药行为”。版权所有©2016约翰威立父子有限公司。
