Brown John R, Oh GYeon, Wang Yanning, Slavova Svetla, Delcher Chris, Dasgupta Nabarun, Freeman Patricia R
Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, Kentucky.
Institute for Pharmaceutical Outcomes and Policy, University of Kentucky College of Pharmacy, Lexington, Kentucky.
J Rural Health. 2021 Jan;37(1):23-28. doi: 10.1111/jrh.12496. Epub 2020 Jul 19.
Abuse-deterrent formulation (ADF) opioid analgesics have been developed as a means to address prescription opioid abuse. ADF opioid use in clinical practice is not well described in the literature. This study characterizes ADF opioid prescribing patterns in 3 diverse states.
This study used data from prescription drug monitoring programs (PDMPs) in California, Florida, and Kentucky. The sample includes all ADF opioid prescriptions for patients ≥18 years old during the study period (CY 2018). Standardized prescribing rates were calculated by age, sex, and county rurality. The ADF opioid prescribing rate was calculated per 1,000 adult recipients of opioid analgesics.
The rate of ADF prescribing per 1,000 adult recipients of opioid analgesics was nearly twice as high in Florida (14.57; 95% CI: 14.44-14.69) than in California (8.30; 95% CI: 8.22-8.37) or Kentucky (8.20; 95% CI: 8.01-8.39). ADF prescribing rates were highest among adults ages 55-74 years and among males. ADF opioid prescribing in rural counties represented a greater proportion of total patients using opioid analgesics than in metro counties in California (RR 1.40; CI: 1.28-1.53). Opposite and less pronounced variation was observed in Kentucky (RR 0.93; 95% CI: 0.88-0.98), and a significant difference was not observed in Florida (RR 0.68; 95% CI: 0.38-1.19).
There were significant differences in the ADF prescribing rates among the 3 states and in rural versus metro counties within 2 states. ADF opioid prescribing by age and sex showed similar trends within states. Further research is needed to elucidate contextual factors which may lead to prescribing variation.
开发具有滥用威慑作用的制剂（ADF）阿片类镇痛药作为解决处方阿片类药物滥用问题的一种手段。ADF阿片类药物在临床实践中的使用情况在文献中描述得并不充分。本研究对三个不同州的ADF阿片类药物处方模式进行了特征分析。
本研究使用了加利福尼亚州、佛罗里达州和肯塔基州处方药监测项目（PDMP）的数据。样本包括研究期间（2018年日历年）所有年龄≥18岁患者的ADF阿片类药物处方。按年龄、性别和农村地区计算标准化处方率。ADF阿片类药物处方率按每1000名阿片类镇痛药成年接受者计算。
每1000名阿片类镇痛药成年接受者的ADF处方率在佛罗里达州（14.57；95%置信区间：14.44 - 14.69）几乎是加利福尼亚州（8.30；95%置信区间：8.22 - 8.37）或肯塔基州（8.20；95%置信区间：8.01 - 8.39）的两倍。ADF处方率在55 - 74岁成年人和男性中最高。加利福尼亚州农村县的ADF阿片类药物处方在使用阿片类镇痛药的总患者中所占比例高于大都市县（相对风险1.40；置信区间：1.28 - 1.53）。在肯塔基州观察到相反且不太明显的差异（相对风险0.93；95%置信区间：0.88 - 0.98），在佛罗里达州未观察到显著差异（相对风险0.68；95%置信区间：0.38 - 1.19）。
三个州之间以及两个州内农村与大都市县之间的ADF处方率存在显著差异。按年龄和性别划分的ADF阿片类药物处方在各州呈现相似趋势。需要进一步研究以阐明可能导致处方差异的背景因素。
