The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College , Hanover , NH , USA.
Emergency Department, Texas Health Resources - Huguley Hospital , Fort Worth , TX , USA.
Clin Toxicol (Phila). 2019 Nov;57(11):1064-1072. doi: 10.1080/15563650.2019.1574976. Epub 2019 Feb 21.
From 1999 to 2010, the annual number of US deaths due to opioid overdose increased about 400% as the number of opioids prescribed yearly also increased by approximately 400%. Over this period, hydrocodone combination products drove the opioid epidemic, as they became the most frequently prescribed medication in the United States. Our objective was to determine if the Drug Enforcement Administration's (DEA) 2014 policy change - which made it more difficult to prescribe hydrocodone combination products by moving them from Schedule III to Schedule II - reduced the total amount of opioid prescriptions as intended. We conducted a longitudinal analysis of the 10 most populous US states, beginning at the time each state began collecting data on opioid prescribing, and concluding at the end of 2016. The exposure was the DEA-mandated October 6, 2014 hydrocodone combination product schedule change. After the DEA's schedule change for hydrocodone combination products, the total number of opioids prescribed each year per 100 people did not substantially change in California, Florida, Michigan, or New York. Although prescription rates dropped for hydrocodone combination products (CA: 43.2, 35.0; MI: 66.8, 55.6; NY: 20.8, 15.1), the reduction was commensurately counteracted by increased rates for tramadol (CA: 0.2, 9.9; MI: 0.1, 17.3; NY: 0.0, 7.6) and oxycodone (CA: 8.7, 9.7; MI: 10.3, 11.9; NY: 18.1, 18.8). Surprisingly, the other 6 states assessed had no viable mechanism in place for assessing state-wide opioid prescription totals, routinely expunged collected data, or only instituted a reporting mechanism toward the end of our study. Total opioid prescriptions were relatively unchanged following the 2014 DEA-mandated schedule change, however, physicians did change their prescribing habits by substituting tramadol for hydrocodone combination products. This substitution of similar medications for hydrocodone suggests alternative approaches are needed to reduce total US opioid prescription rates. Additionally, the current lack of standardized prescription reporting by states makes detailed opioid prescription analysis alarmingly difficult and insufficient to guide policy or monitor the impact of policy changes.
从 1999 年到 2010 年，美国因阿片类药物过量而死亡的人数每年增加约 400%，与此同时，每年开出的阿片类药物处方数量也增加了约 400%。在这期间，氢可酮复方制剂推动了阿片类药物泛滥，因为它成为了美国最常开的药物。我们的目标是确定美国缉毒局（DEA）在 2014 年实施的政策变更——通过将氢可酮复方制剂从附表 III 移至附表 II，从而更难开出氢可酮复方制剂——是否如预期那样减少了阿片类药物的总处方量。我们对美国人口最多的 10 个州进行了纵向分析，从每个州开始收集阿片类药物处方数据的时间开始，到 2016 年底结束。暴露因素是 DEA 于 2014 年 10 月 6 日强制规定的氢可酮复方制剂时间表变更。在 DEA 对氢可酮复方制剂的时间表进行变更后，加利福尼亚州、佛罗里达州、密歇根州或纽约州每年每 100 人开出的阿片类药物总量并没有实质性变化。尽管氢可酮复方制剂的处方率下降（CA：43.2，35.0；MI：66.8，55.6；NY：20.8，15.1），但曲马多（CA：0.2，9.9；MI：0.1，17.3；NY：0.0，7.6）和羟考酮（CA：8.7，9.7；MI：10.3，11.9；NY：18.1，18.8）的使用增加相应地抵消了这种下降。令人惊讶的是，评估的其他 6 个州没有可行的机制来评估全州范围内的阿片类药物处方总量，经常删除收集的数据，或者只是在我们的研究结束时才建立报告机制。2014 年 DEA 强制规定的时间表变更后，阿片类药物的总处方量基本保持不变，然而，医生确实改变了他们的处方习惯，用曲马多代替氢可酮复方制剂。这种用类似药物替代氢可酮的做法表明，需要采取其他方法来降低美国阿片类药物的总处方率。此外，目前各州缺乏标准化的处方报告，使得对阿片类药物的详细处方分析变得非常困难且不足以指导政策或监测政策变化的影响。
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