Borgundvaag Bjug, McLeod Shelley, Khuu Wayne, Varner Catherine, Tadrous Mina, Gomes Tara
Affiliations: Division of Emergency Medicine (Borgundvaag, McLeod, Varner), Department of Family and Community Medicine, University of Toronto; Schwartz/Reisman Emergency Medicine Institute (Borgundvaag, McLeod, Varner), Mount Sinai Hospital; Li Ka Shing Knowledge Institute (Tadrous), St. Michael's Hospital; Institute for Clinical Evaluative Sciences (Khuu, Gomes); Leslie Dan Faculty of Pharmacy (Tadrous, Gomes), University of Toronto, Toronto, Ont.
CMAJ Open. 2018 Mar 1;6(1):E110-E117. doi: 10.9778/cmajo.20170151.
Emergency physicians provide primary care to patients and often prescribe opioids for acutely painful self-limiting conditions. The objective of this study was to describe patterns of opioid prescribing by emergency physicians and family physicians and to explore the relation between setting of initiation of opioid treatment and adverse events over the subsequent 2 years.
This was a population-based cohort study using administrative data from Ontario. Opioid-naive patients aged 15-64 years who received an opioid prescription for noncancer pain from an emergency or family physician between Apr. 1, 2008, and Mar. 31, 2012 were eligible for inclusion.
A total of 34 713 and 45 952 patients were initiated on an opioid by an emergency physicians and family physicians, respectively. Both emergency and family physicians most commonly prescribed codeine-containing products (58.9% and 79.6% of prescriptions, respectively); however, emergency physicians were twice as likely as family physicians to prescribe higher-potency opioids (morphine, oxycodone, hydromorphone, fentanyl, meperidine) (both combination and single-agent preparations) (40.6% v. 19.9%, ∆ = 20.7, 95% confidence interval [CI] 20.0-21.3). Compared to patients in the family physician group, those in the emergency physician group received significantly higher daily dosages, a higher proportion were initiated on a daily dosage of 100 mg of morphine equivalents (MEQs) or more, and had a hospital admission for opioid toxicity within 2 years (0.5% v. 0.3%, ∆ = 0.2%, 95% CI 0.1%-0.3%). A higher proportion of patients in the family physician group than in the emergency physician group had dosage escalation beyond 199 mg MEQs within 2 years (0.7% v. 0.1%, ∆ = 0.6%, 95% CI 0.5%-0.7%).
Codeine was the most common opioid prescribed by emergency and family physicians. Compared to patients prescribed opioids by family physicians, those prescribed opioids by emergency physicians received higher initial daily dosages and had an increased likelihood of opioid toxicity.
急诊医生为患者提供初级护理，并且经常为急性疼痛的自限性疾病开具阿片类药物。本研究的目的是描述急诊医生和家庭医生开具阿片类药物的模式，并探讨阿片类药物治疗起始环境与随后2年不良事件之间的关系。
这是一项基于人群的队列研究，使用安大略省的行政数据。2008年4月1日至2012年3月31日期间，从急诊医生或家庭医生处接受非癌性疼痛阿片类药物处方的15 - 64岁未使用过阿片类药物的患者符合纳入条件。
分别有34713名和45952名患者由急诊医生和家庭医生开始使用阿片类药物。急诊医生和家庭医生最常开具的都是含可待因的产品（分别占处方的58.9%和79.6%）；然而，急诊医生开具高效能阿片类药物（吗啡、羟考酮、氢吗啡酮、芬太尼、哌替啶）（复方制剂和单药制剂）的可能性是家庭医生的两倍（40.6%对19.9%，差值 = 20.7，95%置信区间[CI] 20.0 - 21.3）。与家庭医生组的患者相比，急诊医生组的患者每日剂量显著更高，更高比例的患者起始每日剂量为100毫克吗啡当量（MEQs）或更多，并且在2年内因阿片类药物中毒入院（0.5%对0.3%，差值 = 0.2%，95% CI 0.1% - 0.3%）。家庭医生组中剂量增加超过199毫克MEQs的患者比例高于急诊医生组（0.7%对0.1%，差值 = 0.6%，95% CI 0.5% - 0.7%）。
可待因是急诊医生和家庭医生最常开具的阿片类药物。与由家庭医生开具阿片类药物的患者相比，由急诊医生开具阿片类药物的患者起始每日剂量更高，且阿片类药物中毒的可能性增加。
