Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas.
Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas.
J Am Geriatr Soc. 2018 May;66(5):945-953. doi: 10.1111/jgs.15332. Epub 2018 Apr 14.
To examine how an October 2014 Drug Enforcement Administration policy reclassified hydrocodone product from schedule III to II has affected older adults, who are among the largest consumers of prescription opioids in the United States.
Retrospective cohort study.
United States.
A 20% sample of Medicare Part D beneficiaries aged 65 and older from 2013 through 2015 (> 2,500,000 beneficiaries each year) MEASUREMENTS: From January 2013 to December 2015, we calculated the monthly prevalence of opioid prescriptions and the prevalence of individuals who received prescriptions for a 90-day supply or longer (prolonged), as well as hospitalizations related to opioid toxicity in 2013 and 2015.
From 2013 to 2015, the proportion of Medicare Part D enrollees who received a hydrocodone prescription in a year decreased from 21.9% to 18.3%. Monthly rates for hydrocodone prescriptions declined significantly in 2014. The risk of receiving prolonged opioid prescriptions decreased by approximately 7% in the multivariable analyses comparing 2015 to 2013 (prevalence ratio=0.93, 95% confidence interval (CI)=0.93-0.94). Medicare enrollees with an original entitlement because of disability or with Medicaid eligibility had smaller decreases in prolonged prescriptions and, unexpectedly, small increases in high-dose prescriptions. Opioid-related hospitalizations did not change significantly, but opioid-related hospitalizations without a documented opioid prescription increased (odds ratio=1.24, 95% CI=1.03-1.50).
The 2014 change in hydrocodone from schedule III to schedule II was associated with modest decreases in rates of opioid use in the elderly. The unexpected increase in opioid-related hospitalizations without documented opioid prescriptions may represent an increase in illegal use.
研究 2014 年 10 月美国缉毒局（DEA）将氢可酮产品从附表 III 重新归类为附表 II 的政策如何影响美国最大的处方类阿片类药物使用者之一——老年人。
回顾性队列研究。
美国。
2013 年至 2015 年，从医疗保险处方药受益人（每年>250 万受益人）中抽取 20%的 65 岁及以上的样本。
2013 年 1 月至 2015 年 12 月，我们计算了每月阿片类药物处方的流行率以及接受 90 天或更长时间处方（长期）的个体的流行率，以及 2013 年和 2015 年与阿片类药物毒性相关的住院率。
2013 年至 2015 年，医疗保险 Part D 参保者中一年内接受氢可酮处方的比例从 21.9%降至 18.3%。2014 年，氢可酮处方的月使用率显著下降。与 2013 年相比，2015 年多变量分析显示，接受长期阿片类药物处方的风险降低了约 7%（流行率比=0.93，95%置信区间（CI）=0.93-0.94）。由于残疾而具有原始保险资格或有医疗补助资格的医疗保险参保者，长期处方的减少幅度较小，而高剂量处方的增加幅度较小，这令人意外。阿片类药物相关住院率没有显著变化，但没有阿片类药物处方记录的阿片类药物相关住院率增加（比值比=1.24，95%置信区间（CI）=1.03-1.50）。
2014 年氢可酮从附表 III 改为附表 II，与老年人阿片类药物使用率适度下降有关。令人意外的是，没有阿片类药物处方记录的阿片类药物相关住院率增加可能表明非法使用增加。
