长效羟考酮防篡改制剂引入后加拿大阿片类药物配给的变化：一项时间序列分析。
Changes in the dispensing of opioid medications in Canada following the introduction of a tamper-deterrent formulation of long-acting oxycodone: a time series analysis.
作者信息
Gomes Tara, Mastorakos Andrea, Paterson J Michael, Sketris Ingrid, Caetano Patricia, Greaves Simon, Henry David
机构信息
Affiliations: Li Ka Shing Knowledge Institute of St. Michael's Hospital (Gomes); Institute for Clinical Evaluative Sciences (Gomes, Paterson, Greaves, Henry); Institute of Health Policy, Management, and Evaluation (Gomes, Paterson, Henry), University of Toronto; Leslie Dan Faculty of Pharmacy (Gomes), University of Toronto; Faculty of Arts and Sciences (Mastorakos), University of Toronto, Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; College of Pharmacy (Sketris), Dalhousie University, Halifax, NS; Faculty of Health Sciences (Caetano), University of Manitoba; Provincial Drug Programs (Caetano), Government of Manitoba, Winnipeg, Man.; Centre for Research in Evidence-Based Practice (Henry), Bond University, Gold Coast, Australia.
出版信息
CMAJ Open. 2017 Nov 22;5(4):E800-E807. doi: 10.9778/cmajo.20170104.
BACKGROUND
In February 2012, a reformulated tamper-deterrent form of long-acting oxycodone, OxyNeo, was introduced in Canada. We investigated the impact of the introduction of OxyNeo on patterns of opioid prescribing.
METHODS
We conducted population-based, cross-sectional analyses of opioid dispensing in Canada between 2008 and 2016. We estimated monthly community pharmacy dispensing of oral formulations of codeine, morphine, hydromorphone and oxycodone, and a transdermal formulation of fentanyl, and converted quantities to milligrams of morphine equivalents (MMEs) per 1000 population. We used time series analysis to evaluate the effect of the introduction of OxyNeo on these trends.
RESULTS
National dispensing of long-acting opioids fell by 14.9% between February 2012 and April 2016, from 36 098 MMEs to 30 716 MMEs per 1000 population ( < 0.01). This effect varied across Canada and was largest in Ontario (reduction of 22.8%) ( = 0.01) and British Columbia (reduction of 30.0%) ( = 0.01). The national rate of oxycodone dispensing fell by 46.4% after the introduction of OxyNeo ( < 0.001); this was partially offset by an increase of 47.8% in hydromorphone dispensing ( < 0.001). Although dispensing of immediate-release opioids was a substantial contributor to overall population opioid exposure across Canada, it was unaffected by the introduction of OxyNeo ( > 0.05 in all provinces).
INTERPRETATION
The findings suggest that the introduction of a tamper-deterrent formulation of long-acting oxycodone in Canada, against a background of changing public drug benefits, was associated with sustained changes in selection of long-acting opioids but only small changes in the quantity of long-acting opioids dispensed. This illustrates the limited effect a tamper-deterrent formulation and associated coverage policy can have when other, non-tamper-deterrent alternatives are readily available.
背景
2012年2月，一种重新配方的长效羟考酮防篡改剂型奥施康定（OxyNeo）在加拿大推出。我们调查了奥施康定的引入对阿片类药物处方模式的影响。
方法
我们对2008年至2016年加拿大阿片类药物配药情况进行了基于人群的横断面分析。我们估计了社区药房每月口服可待因、吗啡、氢吗啡酮和羟考酮制剂以及芬太尼透皮制剂的配药量，并将数量换算为每1000人口的吗啡当量毫克数（MMEs）。我们使用时间序列分析来评估奥施康定的引入对这些趋势的影响。
结果
2012年2月至2016年4月期间，加拿大长效阿片类药物的配药量下降了14.9%，从每1000人口36098 MMEs降至30716 MMEs（<0.01）。这种影响在加拿大各地有所不同，在安大略省最大（下降22.8%）（=0.01），在不列颠哥伦比亚省次之（下降30.0%）（=0.01）。奥施康定推出后，全国羟考酮配药率下降了46.4%（<0.001）；这一降幅部分被氢吗啡酮配药量增加47.8%所抵消（<0.001）。尽管速释阿片类药物的配药是加拿大总体人群阿片类药物暴露的一个重要因素，但它不受奥施康定引入的影响（所有省份均>0.05）。
解读
研究结果表明，在公共药物福利不断变化的背景下，加拿大引入长效羟考酮防篡改剂型与长效阿片类药物选择的持续变化有关，但长效阿片类药物配药量的变化很小。这说明了当其他非防篡改替代品容易获得时，防篡改剂型和相关覆盖政策的效果有限。
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