Cepeda M Soledad, Coplan Paul M, Kopper Nathan W, Maziere Jean-Yves, Wedin Gregory P, Wallace Laura E
Department of Epidemiology, Janssen Research and Development, Titusville, New Jersey, NJ, USA.
Department of Risk Management and Epidemiology, Purdue Pharma L.P., Stamford, Connecticut, CT, USA.
Pain Med. 2017 Jan 1;18(1):78-85. doi: 10.1093/pm/pnw129.
Opioid abuse is a serious public health concern. In response, the Food and Drug Administration (FDA) determined that a risk evaluation and mitigation strategy (REMS) for extended-release and long-acting (ER/LA) opioids was necessary to ensure that the benefits of these analgesics continue to outweigh the risks. Key components of the REMS are training for prescribers through accredited continuing education (CE), and providing patient educational materials.
The impact of this REMS has been assessed using diverse metrics including evaluation of prescriber and patient understanding of the risks associated with opioids; patient receipt and comprehension of the medication guide and patient counseling document; patient satisfaction with access to opioids; drug utilization and changes in prescribing patterns; and surveillance of ER/LA opioid misuse, abuse, overdose, addiction, and death.
The results of these assessments indicate that the increasing rates of opioid abuse, addiction, overdose, and death observed prior to implementation of the REMS have since leveled off or started to decline. However, these benefits cannot be attributed solely to the ER/LA opioid analgesics REMS since many other initiatives to prevent abuse occurred contemporaneously. These improvements occurred while preserving patient access to opioids as a large majority of patients surveyed expressed satisfaction with their access to opioids.
阿片类药物滥用是一个严重的公共卫生问题。作为应对措施,美国食品药品监督管理局(FDA)认定,有必要针对缓释和长效(ER/LA)阿片类药物制定风险评估与缓解策略(REMS),以确保这些镇痛药的益处继续大于风险。REMS的关键组成部分包括通过认可的继续教育(CE)对开处方者进行培训,以及提供患者教育材料。
已使用多种指标评估了该REMS的影响,包括评估开处方者和患者对阿片类药物相关风险的理解;患者收到并理解用药指南和患者咨询文件的情况;患者对获取阿片类药物的满意度;药物利用情况和处方模式的变化;以及对ER/LA阿片类药物滥用、误用、过量使用、成瘾和死亡的监测。
这些评估结果表明,在实施REMS之前观察到的阿片类药物滥用、成瘾、过量使用和死亡发生率上升的情况,此后已趋于平稳或开始下降。然而,这些益处不能仅仅归因于ER/LA阿片类药物镇痛剂的REMS,因为许多其他预防滥用的举措也在同时发生。这些改善是在确保患者能够获取阿片类药物的情况下实现的,因为大多数接受调查的患者对获取阿片类药物表示满意。