佛罗里达州处方药监测计划和非法药贩法对高危患者的影响：一项比较性中断时间序列分析
Impact of Florida's prescription drug monitoring program and pill mill law on high-risk patients: A comparative interrupted time series analysis.
作者信息
Chang Hsien-Yen, Murimi Irene, Faul Mark, Rutkow Lainie, Alexander G Caleb
机构信息
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
出版信息
Pharmacoepidemiol Drug Saf. 2018 Apr;27(4):422-429. doi: 10.1002/pds.4404. Epub 2018 Feb 28.
PURPOSE
We quantified the effects of Florida's prescription drug monitoring program and pill mill law on high-risk patients.
METHODS
We used QuintilesIMS LRx Lifelink data to identify patients receiving prescription opioids in Florida (intervention state, N: 1.13 million) and Georgia (control state, N: 0.54 million). The preintervention, intervention, and postintervention periods were July 2010 to June 2011, July 2011 to September 2011, and October 2011 to September 2012. We identified 3 types of high-risk patients: (1) concomitant users: patients with concomitant use of benzodiazepines and opioids; (2) chronic users: long-term, high-dose, opioid users; and (3) opioid shoppers: patients receiving opioids from multiple sources. We compared changes in opioid prescriptions between Florida and Georgia before and after policy implementation among high-risk/low-risk patients. Our monthly measures included (1) average morphine milligram equivalent per transaction, (2) total opioid volume across all prescriptions, (3) average days supplied per transaction, and (4) total number of opioid prescriptions dispensed.
RESULTS
Among opioid-receiving individuals in Florida, 6.62% were concomitant users, 1.96% were chronic users, and 0.46% were opioid shoppers. Following policy implementation, Florida's high-risk patients experienced relative reductions in morphine milligram equivalent (opioid shoppers: -1.08 mg/month, 95% confidence interval [CI] -1.62 to -0.54), total opioid volume (chronic users: -4.58 kg/month, CI -5.41 to -3.76), and number of dispensed opioid prescriptions (concomitant users: -640 prescriptions/month, CI -950 to -340). Low-risk patients generally did not experience statistically significantly relative reductions.
CONCLUSIONS
Compared with Georgia, Florida's prescription drug monitoring program and pill mill law were associated with large relative reductions in prescription opioid utilization among high-risk patients.
目的
我们量化了佛罗里达州的处方药监测计划和“药丸磨坊”法对高危患者的影响。
方法
我们使用昆泰IMS LRx Lifelink数据来识别在佛罗里达州（干预州，N：113万）和佐治亚州（对照州，N：54万）接受处方阿片类药物的患者。干预前、干预期和干预后期分别为2010年7月至2011年6月、2011年7月至2011年9月以及2011年10月至2012年9月。我们识别出3种高危患者类型：（1）合并使用者：同时使用苯二氮䓬类药物和阿片类药物的患者；（2）长期使用者：长期、高剂量使用阿片类药物的患者；（3）阿片类药物购买者：从多个来源接受阿片类药物的患者。我们比较了政策实施前后佛罗里达州和佐治亚州高危/低危患者阿片类药物处方的变化。我们的月度指标包括：（1）每次交易的平均吗啡毫克当量；（2）所有处方中的阿片类药物总量；（3）每次交易的平均供应天数；（4）发放的阿片类药物处方总数。
结果
在佛罗里达州接受阿片类药物的个体中，6.62%为合并使用者，1.96%为长期使用者，0.46%为阿片类药物购买者。政策实施后，佛罗里达州的高危患者在吗啡毫克当量方面出现相对减少（阿片类药物购买者：-1.08毫克/月，95%置信区间[CI]-1.62至-0.54）、阿片类药物总量（长期使用者：-4.58千克/月，CI-5.41至-3.76）以及发放的阿片类药物处方数量（合并使用者：-640张处方/月，CI-950至-340）。低危患者一般未出现统计学上显著的相对减少。
结论
与佐治亚州相比，佛罗里达州的处方药监测计划和“药丸磨坊”法与高危患者处方阿片类药物使用的大幅相对减少有关。
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