加拿大曼尼托巴省牙医的阿片类药物处方：一项纵向分析。

Opioid prescribing by dentists in Manitoba, Canada: A longitudinal analysis.

出版信息

J Am Dent Assoc. 2019 Feb;150(2):122-129. doi: 10.1016/j.adaj.2018.10.024.

DOI:10.1016/j.adaj.2018.10.024

Abstract

BACKGROUND

Overuse of opioids has become a health crisis in the United States and Canada. Opioid prescribing practices have subsequently come under scrutiny, with limited study regarding prescribing patterns of dentists.

METHODS

A longitudinal analysis was conducted on all adult patients to whom an opioid was dispensed from 2014 through 2017 in Manitoba, Canada. Rates of dental opioid prescribing, milligram morphine equivalents (MMEs) per prescription, and guideline adherence were determined. Additional analyses evaluated the contribution of dentist prescribing to first opioid use and opioid use 90 days before and after first dental opioid prescription.

RESULTS

Dentist prescriptions accounted for 3.8% of all opioid prescriptions and 0.58% of total MMEs. Codeine with acetaminophen combinations were the primary opioid prescribed (97.4%), followed by tramadol/acetaminophen (1.7%) and oxycodone with acetaminophen (0.7%). Overall, 30 or less tablets were supplied in 96.1% of prescriptions. Prescriptions were written for 5 or less days in 89.1% of cases and for 7 or less days in 95.2% of cases. In the 90-day before-after analysis, 87.8% of patients received only 1 prescription from their dentist, with an additional 9.8% receiving only 2 prescriptions. Dentists were responsible for 20.6% of first opioid prescriptions, with 5.6% written for 50 or more MMEs per day.

CONCLUSIONS

Compared with available guidelines, prescribed quantities were mostly appropriate, suggesting that the overall contribution of dentists to opioid overuse is limited.

PRACTICAL IMPLICATIONS

Dental opioid stewardship can be encouraged through an enhanced regulatory monitoring program with local review to guide efforts to further improve opioid prescribing. Continued efforts are warranted to prescribe smaller quantities and for greater avoidance of opioid use for dental pain.

摘要

背景

在美国和加拿大，阿片类药物的过度使用已成为一场健康危机。因此，阿片类药物的处方实践受到了严格审查，而关于牙医处方模式的研究却很有限。

方法

对 2014 年至 2017 年间在加拿大马尼托巴省开具阿片类药物的所有成年患者进行了一项纵向分析。确定了牙科阿片类药物的处方率、每处方吗啡等效剂量 (MME) 和遵循指南的情况。进一步的分析评估了牙医处方对首次使用阿片类药物和首次牙科阿片类药物处方前 90 天和后 90 天使用阿片类药物的影响。

结果

牙医处方占所有阿片类药物处方的 3.8%，占总 MME 的 0.58%。可待因与对乙酰氨基酚的复方制剂是主要开具的阿片类药物（97.4%），其次是曲马多/对乙酰氨基酚（1.7%）和对乙酰氨基酚与羟考酮（0.7%）。总体而言，96.1%的处方中提供的药片数为 30 片或以下。89.1%的病例开具的处方使用时间为 5 天或以下，95.2%的病例开具的处方使用时间为 7 天或以下。在前后 90 天的分析中，87.8%的患者仅从其牙医处获得 1 张处方，另有 9.8%的患者仅获得 2 张处方。牙医开具的处方占首次阿片类药物处方的 20.6%，其中 5.6%的处方每天开具 50 毫克或更多的 MME。