College of Medicine (Hartmann, Elder) and Department of Emergency Medicine (Hartmann, Elder, Terrett), University of Saskatchewan; Department of Adult Critical Care Medicine (Terrett), Saskatchewan Health Authority, Saskatoon, Sask.
CMAJ Open. 2021 Jan 29;9(1):E79-E86. doi: 10.9778/cmajo.20200071. Print 2021 Jan-Mar.
Deaths related to opioid overdoses are increasing in North America, with the emergency department being identified as a potential contributor toward this epidemic. Our goal was to determine whether a departmental guideline for the prescribing of restricted medications resulted in a reduction in opioids prescribed in a Canadian setting, with a secondary objective of determining the impact on local overdose frequency.
We conducted a retrospective analysis of the prescribing habits of emergency department physicians in 3 hospitals in the Saskatoon Health Region, Saskatchewan, before (Nov. 1, 2015, to Apr. 30, 2016) and after (Nov. 1, 2016, to Apr. 30, 2017) implementation of a guideline in September 2016 for the prescribing of restricted medications. We quantified opioids prescribed per hour worked and per patient seen. We performed Student paired 2-tailed tests for both individual drug formulations and the combined total morphine equivalents.
Thirty-two emergency department physicians were included. We found a decrease of 31.1% in opioids prescribed, from 10.36 morphine milligram equivalents (MME) per patient seen to 7.14 MME per patient seen (absolute change -3.22 MME, 95% confidence interval -4.81 to -1.63 MME). Over the same period, we found no change in prehospital naloxone use and a modest increase in the amount of naloxone dispensed by emergency department pharmacies. There was no decrease in the number of overdoses after guideline implementation.
Implementation of a guideline for the prescribing of restricted medications in a Canadian emergency department setting was associated with a decrease in the quantity of opioids prescribed but not in the number of overdoses. This finding suggests that the emergency department is unlikely the source of opioids used in acute overdose, although emergency department opioid prescriptions cannot be ruled out as a risk factor for opioid use disorder.
在北美，与阿片类药物过量相关的死亡人数正在增加，急诊被认为是导致这一流行的潜在因素。我们的目标是确定在加拿大环境中，为限制药物开处方的部门指南是否会减少开处的阿片类药物，次要目标是确定其对当地过量用药频率的影响。
我们对萨斯喀彻温省萨斯卡通地区 3 家医院的急诊医生的处方习惯进行了回顾性分析，在 2016 年 9 月实施限制药物处方指南之前（2015 年 11 月 1 日至 2016 年 4 月 30 日）和之后（2016 年 11 月 1 日至 2017 年 4 月 30 日）。我们量化了每小时工作和每例就诊开处的阿片类药物。我们对个别药物制剂和总吗啡等效物进行了学生配对双侧 2 尾检验。
共纳入 32 名急诊医生。我们发现，每例就诊开处的阿片类药物减少了 31.1%，从 10.36 吗啡毫克当量（MME）降至 7.14 MME（绝对变化-3.22 MME，95%置信区间-4.81 至-1.63 MME）。同期，我们发现院前纳洛酮使用率没有变化，急诊药房分发的纳洛酮量略有增加。指南实施后，过量用药的数量没有减少。
在加拿大急诊环境中，为限制药物开处方制定指南与开处的阿片类药物数量减少有关，但与过量用药数量无关。这一发现表明，急诊部门不太可能是急性过量用药中阿片类药物的来源，尽管急诊部门的阿片类药物处方不能排除作为阿片类药物使用障碍的风险因素。
