Lawrence Amy, Cooper Jennifer N, Deans Katherine J, Minneci Peter C, Wrona Sharon K, Chisolm Deena J
Nationwide Children's Hospital, Columbus, OH, USA.
Glob Pediatr Health. 2021 Jan 15;8:2333794X20987444. doi: 10.1177/2333794X20987444. eCollection 2021.
Our objective was to examine the impact of the U.S. FDA's 2013 black box warning against codeine on codeine and other opioid prescription filling after pediatric tonsillectomy and/or adenoidectomy (T/A) overall and by child race and provider urbanity/rurality. Patients ≤ 18 who underwent T/A in 8/2011 to 8/2016 were identified in Ohio Medicaid claims. Interrupted time series analyses were used to evaluate the impact of the FDA warning on codeine or other opioid prescription filling post-T/A. In August 2011, codeine prescription filling was lower among black than white children ( < .001) and among children treated at institutions in metropolitan counties than less populous counties ( < .001). The FDA warning was associated with a 24.0% drop in codeine prescription filling ( < .001) and 5.5% increase in alternative opioid prescription filling ( = .046). At conclusion, there remained geographic but no longer racial disparities in codeine prescribing. Codeine prescribing after pediatric T/A decreased after the FDA's black box warning. However, geographic disparities in codeine prescribing remain.
我们的目标是研究美国食品药品监督管理局（FDA）2013年对可待因发出的黑框警告对小儿扁桃体切除和/或腺样体切除（T/A）术后可待因及其他阿片类药物处方配药的影响，总体情况以及按儿童种族和医疗服务提供者所在地区的城乡差异进行分析。在俄亥俄州医疗补助索赔记录中识别出2011年8月至2016年8月期间接受T/A手术的18岁及以下患者。采用中断时间序列分析来评估FDA警告对T/A术后可待因或其他阿片类药物处方配药的影响。2011年8月，黑人儿童的可待因处方配药率低于白人儿童（P<0.001），在大都市县机构接受治疗的儿童的可待因处方配药率低于人口较少县的儿童（P<0.001）。FDA的警告与可待因处方配药下降24.0%（P<0.001）以及替代阿片类药物处方配药增加5.5%（P=0.046）相关。结论是，可待因处方存在地理差异，但不再存在种族差异。FDA发出黑框警告后，小儿T/A术后的可待因处方量减少。然而，可待因处方的地理差异仍然存在。
