Brown Richard, Riley Moira R, Ulrich Lydia, Kraly Ellen Percy, Jenkins Paul, Krupa Nicole L, Gadomski Anne
Bassett Healthcare Network, Psychiatry,1 Atwell Rd., Cooperstown, NY 13326, USA.
Bassett Healthcare Network, Research Institute,1 Atwell Rd., Cooperstown, NY 13326, USA,.
Drug Alcohol Depend. 2017 Sep 1;178:348-354. doi: 10.1016/j.drugalcdep.2017.05.023. Epub 2017 Jun 23.
Prescription Drug Monitoring programs (PDMPs) are intended to reduce opioid prescribing and aberrant drug-related behavior thereby reducing morbidity and mortality due to prescription opioid overdose. Expansion of the New York (NY) State's PDMP in 2013 included the institution of the I-STOP law that mandated clinicians to consult the statewide PDMP database to review the patient's prescription history prior to prescribing opioids.
Trends in prescription opioid distribution, prescribing, and prescription opioid and heroin overdose morbidity in NY were analyzed using time series. A Chow test was used to test the difference in trends before and after the implementation of I-STOP.
The results indicated that: 1) the number of opioid prescriptions appears to be declining following the implementation of the I-STOP, 2) however, supply chain data shows that the total quantity of opioids in the supply chain increased, 3) statewide trends in inpatient and emergency department visits for prescription opioid overdose increased from 2010 to the third quarter of 2013 where the slope leveled off following I-STOP, but this change in slope was not significant, 4) visits for heroin overdose started escalating in 2010 and continued to increase through the second quarter of 2016. The overall significance of these findings show a small impact of PDMPs on prescription opioid overdose morbidity in NY in the context of the increasing national trend during this time period.
Prescription opioid morbidity leveled off following the implementation of a mandated PDMP although morbidity attributable to heroin overdose continued to rise.
处方药监测项目（PDMPs）旨在减少阿片类药物的处方开具及异常药物相关行为，从而降低因处方阿片类药物过量导致的发病率和死亡率。2013年纽约州（NY）扩大了其PDMP，其中包括实施I-STOP法案，该法案要求临床医生在开具阿片类药物之前，查阅全州的PDMP数据库以审查患者的用药史。
采用时间序列分析纽约州处方阿片类药物的分发、处方开具趋势以及处方阿片类药物和海洛因过量导致的发病率。使用邹氏检验来检验I-STOP实施前后趋势的差异。
结果表明：1）I-STOP实施后，阿片类药物处方数量似乎在下降；2）然而，供应链数据显示，供应链中的阿片类药物总量增加；3）2010年至2013年第三季度，全州因处方阿片类药物过量导致的住院和急诊就诊趋势上升，I-STOP实施后斜率趋于平稳，但斜率的这种变化并不显著；4）海洛因过量导致的就诊人数自2010年开始上升，并持续增加至2016年第二季度。这些发现的总体显著性表明，在此期间全国趋势上升的背景下，PDMPs对纽约州处方阿片类药物过量导致的发病率影响较小。
强制实施PDMP后，处方阿片类药物导致的发病率趋于平稳，尽管海洛因过量导致的发病率持续上升。
