Global Health and International Comparative Government, Duke University, Durham, NC, USA.
Global Health Outcomes and Real-World Evidence Generation, Incyte Pharma, Wilmington, DE, USA.
Curr Pain Headache Rep. 2019 Aug 6;23(10):76. doi: 10.1007/s11916-019-0777-x.
Deaths associated to tramadol, a synthetic opioid, are rising globally. Herein, we characterize prescription patterns of tramadol relative to other opioids in the USA from 2012 to 2015, by geographic region and physician specialty.
Data on opioid was obtained using Truven Health Analytics MarketScan for the years 2012-2015. Inclusion criteria included subjects living in the USA with ages from 12 to 64 years. Patterns of prescription of tramadol were contrasted with other prescription opioids including hydrocodone, codeine, oxycodone, oxymorphone, methadone, and fentanyl. Between 2012 and 2015, prescriptions for tramadol increased by 22.8%. The absolute rate of prescription varies considerably per region, with tramadol representing nearly 20% of opioid prescriptions in the South, which, in turn, represents nearly 50% of all prescriptions in the USA. Significant differences were seen when comparing prescribers of tramadol with other opioids (p < 0.0001). Tramadol was more frequently prescribed by family practice (40% vs. 32%) and internal medicine physicians (19% vs. 16%). Family medicine, internal medicine, and non-physician prescribers responded by 67.2% of all tramadol prescriptions in 2015. The proportion of patients receiving tramadol from non-physician prescribers increased by 56% between 2012 and 2015 (p < 0.001) IOM. Tramadol prescriptions rates have continuously increased both nationally and throughout all US regions. Important differences exist among regions and physician specialties. These results may be helpful in the creation of regional policies to monitor reasons for this increase and to avoid excessive use of tramadol.
目的综述：曲马多，一种人工合成阿片类药物，与全球范围内的死亡事件上升有关。本文描述了 2012 年至 2015 年期间美国不同地区和医师专业领域曲马多相对于其他阿片类药物的处方模式。
发现：2012-2015 年，使用 Truven Health Analytics MarketScan 数据库获取阿片类药物数据。纳入标准包括年龄 12-64 岁、居住在美国的受试者。将曲马多的处方模式与其他处方阿片类药物（氢可酮、可待因、羟考酮、羟吗啡酮、美沙酮和芬太尼）进行对比。2012 年至 2015 年，曲马多处方增加了 22.8%。每个地区的处方率差异很大，在南部地区，曲马多占阿片类药物处方的近 20%，而南部地区的处方又占美国所有处方的近 50%。与其他阿片类药物的开方者相比，曲马多的开方者存在显著差异（p<0.0001）。家庭医生（40%比 32%）和内科医生（19%比 16%）更常开曲马多。2015 年，家庭医生、内科医生和非医师处方者开具了所有曲马多处方的 67.2%。2012 年至 2015 年间，从非医师处方者处获得曲马多的患者比例增加了 56%（p<0.001）。全国和全美各地区的曲马多处方率都在持续上升。地区和医师专业之间存在显著差异。这些结果有助于制定区域性政策，以监测这种增加的原因，并避免曲马多的过度使用。
