Ranapurwala Shabbar I, Ringwalt Christopher L, Pence Brian W, Schiro Sharon, Fulcher Naoko, McCort Agnieszka, DiPrete Bethany L, Marshall Stephen W
Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina; Injury Prevention Research Center, University of North Carolina, Chapel Hill, North Carolina.
Injury Prevention Research Center, University of North Carolina, Chapel Hill, North Carolina.
Am J Prev Med. 2021 Mar;60(3):343-351. doi: 10.1016/j.amepre.2020.09.015. Epub 2020 Dec 10.
In March 2016, the Centers for Disease Control and Prevention issued opioid prescribing guidelines for chronic noncancer pain. In response, in April 2016, the North Carolina Medical Board launched the Safe Opioid Prescribing Initiative, an investigative program intended to limit the overprescribing of opioids. This study focuses on the association of the Safe Opioid Prescribing Initiative with immediate and sustained changes in opioid prescribing among all patients who received opioid and opioid discontinuation and tapering among patients who received high-dose (>90 milligrams of morphine equivalents), long-term (>90 days) opioid therapy.
Controlled and single interrupted time series analysis of opioid prescribing outcomes before and after the implementation of Safe Opioid Prescribing Initiative was conducted using deidentified data from the North Carolina Controlled Substances Reporting System from January 2010 through March 2017. Analysis was conducted in 2019-2020.
In an average study month, 513,717 patients, including patients who received 47,842 high-dose, long-term opioid therapy, received 660,912 opioid prescriptions at 1.3 prescriptions per patient. There was a 0.52% absolute decline (95% CI= -0.87, -0.19) in patients receiving opioid prescriptions in the month after Safe Opioid Prescribing Initiative implementation. Abrupt discontinuation, rapid tapering, and gradual tapering of opioids among patients who received high-dose, long-term opioid therapy increased by 1% (95% CI= -0.22, 2.23), 2.2% (95% CI=0.91, 3.47), and 1.3% (95% CI=0.96, 1.57), respectively, in the month after Safe Opioid Prescribing Initiative implementation.
Although Safe Opioid Prescribing Initiative implementation was associated with an immediate decline in overall opioid prescribing, it was also associated with an unintended immediate increase in discontinuations and rapid tapering among patients who received high-dose, long-term opioid therapy. Better policy communication and prescriber education regarding opioid tapering best practices may help mitigate unintended consequences of statewide policies.
2016年3月，美国疾病控制与预防中心发布了针对慢性非癌性疼痛的阿片类药物处方指南。作为回应，2016年4月，北卡罗来纳州医学委员会发起了“安全阿片类药物处方倡议”，这是一项旨在限制阿片类药物过度处方的调查项目。本研究重点关注“安全阿片类药物处方倡议”与所有接受阿片类药物治疗患者的阿片类药物处方的即时和持续变化之间的关联，以及接受高剂量（>90毫克吗啡当量）、长期（>90天）阿片类药物治疗患者的阿片类药物停药和减量情况。
利用北卡罗来纳州管制物质报告系统2010年1月至2017年3月的去识别化数据，对“安全阿片类药物处方倡议”实施前后的阿片类药物处方结果进行对照和单中断时间序列分析。分析于2019 - 2020年进行。
在一个平均研究月中，513,717名患者（包括47,842名接受高剂量、长期阿片类药物治疗的患者）共获得660,912张阿片类药物处方，人均1.3张。在“安全阿片类药物处方倡议”实施后的那个月，接受阿片类药物处方的患者数量绝对下降了0.52%（95%置信区间 = -0.87，-0.19）。在“安全阿片类药物处方倡议”实施后的那个月，接受高剂量、长期阿片类药物治疗的患者中，阿片类药物的突然停药、快速减量和逐渐减量分别增加了1%（95%置信区间 = -0.22，2.23）、2.2%（95%置信区间 = 0.91，3.47）和1.3%（95%置信区间 = 0.96，1.57）。
虽然“安全阿片类药物处方倡议”的实施与总体阿片类药物处方的即时下降有关，但也与接受高剂量、长期阿片类药物治疗的患者停药和快速减量的意外即时增加有关。关于阿片类药物减量最佳实践的更好政策沟通和处方医生教育可能有助于减轻全州政策的意外后果。
