MMWR Morb Mortal Wkly Rep. 2016 Oct 21;65(41):1125-1131. doi: 10.15585/mmwr.mm6541a1.
Overdose deaths involving opioid pain medications are epidemic in the United States, in part because of high opioid prescribing rates and associated abuse of these drugs (1). In 2014, nearly 2 million U.S. residents either abused or were dependent on prescription opioids (2). In Massachusetts, unintentional opioid-related overdose deaths, including deaths involving heroin, increased 45% from 2012 to 2013.* In 2014, the rate of these deaths reached 20.0 per 100,000, nearly 2.5 times higher than the U.S. rate overall (3,4). On July 1, 2012, Blue Cross Blue Shield of Massachusetts (BCBSMA), the largest insurer in the state with approximately 2.8 million members, implemented a comprehensive opioid utilization program after learning that many of its members were receiving new prescriptions with a >30-day supply of opioids. The 2016 CDC Guideline for Prescribing Opioids for Chronic Pain recommends avoiding opioids as a first-line therapy for chronic pain and limiting quantities when initiating opioids for acute pain (5). CDC analyzed BCBSMA prescription claims data for the period 2011-2015 to assess the effect of the new utilization program on opioid prescribing rates. During the first 3 years after policy implementation, the average monthly prescribing rate for opioids decreased almost 15%, from 34 per 1,000 members to 29. The percentage of BCBSMA members per month with current opioid prescriptions also declined. The temporal association between implementation of the program and statistically significant declines in both prescribing rates and proportion of members using opioids suggests that the BCBSMA initiative played a role in reducing the use of prescription opioids among its members. Public and private insurers in the United States could benefit from developing their own best practices for prescription opioid utilization that ensure accessible pain care, while reducing the risk for dependence and abuse associated with these drugs.
美国阿片类止痛药过量死亡人数居高不下，部分原因是阿片类药物的处方率较高，以及这些药物的滥用情况严重。2014 年，近 200 万美国居民滥用或依赖处方阿片类药物。在马萨诸塞州，2012 年至 2013 年，与阿片类药物相关的非故意过量用药死亡人数（包括涉及海洛因的死亡人数）增加了 45%。2014 年，这些死亡人数达到每 10 万人 20.0 例，几乎是美国总体死亡率的 2.5 倍。2012 年 7 月 1 日，马萨诸塞州最大的保险公司——蓝十字蓝盾公司（BCBSMA），在了解到其许多成员收到含有超过 30 天供应量的阿片类药物的新处方后，实施了一项全面的阿片类药物使用方案。2016 年疾病预防控制中心（CDC）阿片类药物治疗慢性疼痛指南建议避免将阿片类药物作为慢性疼痛的一线治疗药物，并在开始使用阿片类药物治疗急性疼痛时限制用量。疾病预防控制中心分析了 2011 年至 2015 年期间 BCBSMA 的处方索赔数据，以评估新的使用方案对阿片类药物处方率的影响。在政策实施后的头 3 年里，阿片类药物的平均每月处方率下降了近 15%，从每 1000 名成员 34 例降至 29 例。每月有阿片类药物当前处方的 BCBSMA 成员比例也有所下降。该方案的实施与处方率和使用阿片类药物的成员比例均呈统计学显著下降之间的时间关联表明，BCBSMA 的倡议在减少其成员使用处方阿片类药物方面发挥了作用。美国的公共和私人保险公司可以从制定自己的最佳处方阿片类药物使用实践中受益，这些实践既能确保获得疼痛治疗，又能降低与这些药物相关的依赖和滥用风险。
