Department of Anesthesiology and Critical Care, Perelman School of Medicine and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
Department of Anesthesia, Perioperative, and Pain Medicine, and Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
Lancet. 2019 Apr 13;393(10180):1547-1557. doi: 10.1016/S0140-6736(19)30428-3.
Worldwide, the use of prescription opioid analgesics more than doubled between 2001 and 2013, with several countries, including the USA, Canada, and Australia, experiencing epidemics of opioid misuse and abuse over this period. In this context, excessive prescribing of opioids for pain treatment after surgery has been recognised as an important concern for public health and a potential contributor to patterns of opioid misuse and related harm. In the second paper in this Series we review the evolution of prescription opioid use for pain treatment after surgery in the USA, Canada, and other countries. We summarise evidence on the extent of opioid overprescribing after surgery and its potential association with subsequent opioid misuse, diversion, and the development of opioid use disorder. We discuss evidence on patient, physician, and system-level predictors of excessive prescribing after surgery, and summarise recent work on clinical and policy efforts to reduce such prescribing while ensuring adequate pain control.
全球范围内，2001 年至 2013 年间处方类阿片类镇痛药的使用量增加了一倍多，在此期间，包括美国、加拿大和澳大利亚在内的几个国家都经历了阿片类药物滥用和误用的流行。在这种情况下，人们认识到手术后过度开具阿片类药物治疗疼痛是一个重要的公共卫生问题，也是导致阿片类药物滥用和相关伤害模式的潜在因素。在本系列的第二篇文章中，我们回顾了美国、加拿大和其他国家手术后疼痛治疗中处方类阿片类药物使用的演变情况。我们总结了手术后阿片类药物过度开方的程度及其与随后的阿片类药物滥用、转移和阿片类药物使用障碍发展的潜在关联的证据。我们讨论了手术后过度处方的患者、医生和系统水平预测因素的证据，并总结了最近在减少这种处方的同时确保充分疼痛控制的临床和政策努力方面的工作。
