Shipton Elspeth E, Shipton Ashleigh J, Williman Jonathan A, Shipton Edward A
Department of Anaesthesia, University of Otago, Christchurch, New Zealand.
Department of Population Health, University of Otago, Christchurch, New Zealand.
Pain Ther. 2017 Dec;6(2):203-215. doi: 10.1007/s40122-017-0080-7. Epub 2017 Sep 8.
In the late 1990s multiple physicians and advocacy organizations promoted increased use of opioids for the treatment of acute, chronic and cancer pain. There has been an exponential growth in opioid prescribing in the last 20 years in the United States of America, in Australia, and in other developed Western countries. There are negative consequences associated with the liberal use of opioids. The primary aim of this population-based cohort study is to investigate the opioid-related death rate in New Zealand between 1 January 2008 and 31 December 2012. The secondary aims of this cohort study are: (1) to compare the opioid-related death rate per population in New Zealand in 2001/2002 with that between 2011/2012; (2) to investigate the number of opioid prescriptions in New Zealand between 2001 and 2012; (3) to compare the opioid-related death rate per population in New Zealand between 2001 and 2012 with the number of opioid prescriptions in New Zealand between 2001 and 2012.
Permission to access records from the Coronial Services Office in Wellington for 2008-2012 was acquired. Permission to access records for prescriptions containing opioids (dose and formulation) was obtained from the Pharmaceutical Collection.
The rate of opioid-related deaths in New Zealand has increased by 33% from 2001 to 2012. More than half of the opioid-related deaths between 2008 and 2012 were unintentional opioid overdoses. Opioid analgesic deaths were most likely due to methadone, morphine and codeine prescribed by healthcare professionals. That 179 of these opioid-related deaths between 2008 and 2012 were unintentional opioid overdoses, and thus could have been avoided, is tragic. This study shows that there was a steady annual increases in opioid prescriptions in New Zealand from 2001 to 2012. This rise in opioid analgesic deaths was associated with the increases in the numbers of opioid prescriptions.
A multifaceted national public health approach is needed to bring together the various stakeholders involved with pain management, opioid dependence, opioid availability and opioid diversion. There needs to be a targeted approach to educate current and future medical practitioners regarding the appropriate use of opioid prescriptions for the management of pain, as well as a strengthening of primary, secondary and tertiary resources to support medical practitioners managing their patients who suffer with pain.
20世纪90年代末，多位医生和倡导组织推动增加阿片类药物在急性、慢性和癌症疼痛治疗中的使用。在过去20年里，美国、澳大利亚和其他西方发达国家的阿片类药物处方量呈指数级增长。阿片类药物的随意使用会带来负面影响。这项基于人群的队列研究的主要目的是调查2008年1月1日至2012年12月31日期间新西兰与阿片类药物相关的死亡率。该队列研究的次要目的是：（1）比较2001/2002年和2011/2012年新西兰每人口中与阿片类药物相关的死亡率；（2）调查2001年至2012年期间新西兰的阿片类药物处方数量；（3）比较2001年至2012年新西兰每人口中与阿片类药物相关的死亡率和2001年至2012年新西兰的阿片类药物处方数量。
获得了惠灵顿验尸官服务办公室2008 - 2012年记录的访问许可。从药品收集处获得了包含阿片类药物（剂量和剂型）处方记录的访问许可。
从2001年到2012年，新西兰与阿片类药物相关的死亡率上升了33%。2008年至2012年期间，超过一半的与阿片类药物相关的死亡是阿片类药物意外过量。阿片类镇痛药物死亡最有可能是由于医疗专业人员开具的美沙酮、吗啡和可待因。2008年至2012年期间，这些与阿片类药物相关的死亡中有179例是阿片类药物意外过量，因此本可避免，这是悲剧性的。这项研究表明，2001年至2012年期间新西兰的阿片类药物处方量逐年稳步增加。阿片类镇痛药物死亡人数的增加与阿片类药物处方数量的增加有关。
需要采取多方面的国家公共卫生方法，将参与疼痛管理、阿片类药物依赖、阿片类药物可得性和阿片类药物转移的各利益相关方聚集在一起。需要有针对性地对当前和未来的医疗从业者进行教育，使其了解阿片类药物处方在疼痛管理中的合理使用，同时加强初级、二级和三级资源，以支持医疗从业者管理疼痛患者。
