Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts.
Harvard Medical Toxicology Program, Boston Children's Hospital, Boston, Massachusetts.
JAMA Pediatr. 2020 Oct 1;174(10):961-968. doi: 10.1001/jamapediatrics.2020.1980.
Opioid-reduction policies have been enacted by US states to address the opioid epidemic. Evidence of an association between policy implementation and decreased rates of pediatric opioid poisoning provides further justification for expanded implementation of these policies.
To examine the association of 3 state-level opioid-reduction policies with the rate of opioid poisoning in children and adolescents.
DESIGN, SETTING, AND PARTICIPANTS: This interrupted time series analysis used data from the National Poison Data System (NPDS), a database of poisoning information reported to poison control centers across the US. Individuals younger than 20 years who experienced poisoning associated with 1 or more prescription opioids from January 1, 2005, to November 30, 2017, were included. The analysis focused on 3 widespread policy interventions: the prescription drug monitoring program (PDMP), pain clinic legislation, and opioid prescribing guidelines. Data analysis was performed from January 30, 2020, to March 30, 2020.
Any opioid poisoning in individuals younger than 20 years that was reported to the NPDS.
Opioid poisoning rates per million person-months before and after implementation of each of the 3 policies, overall and stratified by age (≤4 years, 5-9 years, 10-14 years, and 15-19 years).
A total of 338 476 opioid poisoning incidences in children and young adults were reported to the NPDS within the study period. Of this study population, the mean (SD) age was 9.74 (7.15) years, and 179 011 (52.9%) were female. The implementation of a PDMP was associated with a reduction in the monthly rate of opioid poisoning in children and adolescents (-0.07 per million person-months; 95% CI, -0.09 to -0.04) in the postimplementation period. This reduction was observed for all age groups except for the 10- to 14-year age group (-0.03 per million person-months; 95% CI, -0.05 to 0.00). Pain clinic legislation was associated with an immediate reduction in opioid poisoning (-6.22 per million person-months; 95% CI, -8.98 to -3.47). This association was statistically significant across all ages except for the 4 years or younger group. Analysis of the association of implementation of opioid prescribing guidelines was limited because of insufficient follow-up data and did not show an immediate or monthly change in the rate of opioid poisoning.
Results of this study suggest that certain state-level opioid-reduction policies were associated with decreases in pediatric opioid exposures across age groups. Further examination of the underlying mechanisms of these associations, including age group-specific outcomes, may expand and strengthen policies that reduce opioid poisoning, misuse, and overdoses in children and adolescents.
美国各州已经制定了阿片类药物减少政策，以应对阿片类药物泛滥问题。政策实施与儿童阿片类药物中毒率降低之间存在关联的证据，进一步证明了扩大实施这些政策的合理性。
研究 3 项州级阿片类药物减少政策与儿童和青少年阿片类药物中毒率之间的关联。
设计、地点和参与者：本中断时间序列分析使用了来自全美毒物控制中心报告的中毒信息数据库——国家毒物数据系统（NPDS）的数据。纳入 2005 年 1 月 1 日至 2017 年 11 月 30 日期间因 1 种或多种处方阿片类药物中毒而年龄小于 20 岁的个体。分析重点关注 3 种广泛的政策干预措施：处方药物监测计划（PDMP）、疼痛诊所立法和阿片类药物处方指南。数据分析于 2020 年 1 月 30 日至 3 月 30 日进行。
向 NPDS 报告的任何年龄小于 20 岁的个体的阿片类药物中毒。
在实施每一项政策前后，每百万个人月的阿片类药物中毒率，总体和按年龄分层（≤4 岁、5-9 岁、10-14 岁和 15-19 岁）。
在研究期间，NPDS 共报告了 338476 例儿童和年轻人的阿片类药物中毒事件。在该研究人群中，平均（SD）年龄为 9.74（7.15）岁，179011 人（52.9%）为女性。PDMP 的实施与儿童和青少年阿片类药物中毒月率的降低相关（实施后每月减少 0.07/百万个人月；95%CI，-0.09 至-0.04）。除 10-14 岁年龄组（每月减少 0.03/百万个人月；95%CI，-0.05 至 0.00）外，所有年龄组均观察到这种降低。疼痛诊所立法与阿片类药物中毒的立即减少相关（每月减少 6.22/百万个人月；95%CI，-8.98 至-3.47）。除 4 岁或以下年龄组外，这种关联在所有年龄组均具有统计学意义。由于随访数据不足，对实施阿片类药物处方指南的关联分析受到限制，且未显示阿片类药物中毒率的即时或每月变化。
本研究结果表明，某些州级阿片类药物减少政策与各年龄段儿童阿片类药物暴露的降低有关。进一步研究这些关联的潜在机制，包括按年龄组划分的结果，可能会扩大和加强减少儿童和青少年阿片类药物中毒、滥用和过量的政策。
