Division of Infectious Diseases, University of California, Los Angeles, CA, USA.
David Geffen School of Medicine, Center for Social Medicine and Humanities, University of California, Los Angeles, CA, USA.
Lancet Public Health. 2021 Feb;6(2):e88-e96. doi: 10.1016/S2468-2667(20)30260-7.
In 2015, Mexico implemented regulatory changes and an electronic system to improve access to prescription opioids. We aimed to investigate trends in opioid dispensing after the implementation of these changes and assess how opioid dispensing varied geographically and by socioeconomic status.
In this retrospective analysis of prescription medication surveillance data, we analysed dispensing data for group 1 medications (all opioids, including morphine, methadone, hydromorphone, oxycodone, tapentadol, fentanyl, sufentanil, and remifentanil) obtained from the Federal Commission for the Protection against Sanitary Risk database for 32 states and six large metropolitan areas in Mexico. We calculated crude annual opioid prescriptions per 10 000 people at the national, state, and municipal levels. Adapting methods from the report of the Lancet Commission on Palliative Care and Pain Relief, we calculated the need for palliative opioids by state, and then assessed the observed opioid dispensing rates as a percentage of expected need by geographical socioeconomic status. Within the six major metropolitan areas, we mapped the geocoded location of opioid prescriptions and assessed the association between opioid dispensing and socioeconomic status as well as the association between opioid dispensing and time to US border crossing for areas on the US-Mexico border.
Between June 25, 2015, and Oct 7, 2019, opioid dispensing rates increased by an average of 13% (95% CI 6·8-19·6) per quarter (3 months). The overall national opioid dispensing rate during the study period was 26·3 prescriptions per 10 000 inhabitants. States with a higher socioeconomic status had higher opioid dispensing rates than states with lower socioeconomic status (rate ratio [RR] 1·88, 95% CI 1·33-2·58, p=0·00016) after controlling for the estimated opioid requirement per state, the presence of methadone clinics, and the presence of tertiary hospitals and cancer centres. The same association between opioid dispensing and socioeconomic status was observed in the metropolitan areas, and in those metropolitan areas on the US-Mexico border a 20% decrease (RR 0·80, 95% CI 0·75-0·86) in opioid dispensation was observed per each SD increase (SD 17·1 min) in travel time to the border.
Measures introduced by the Mexican federal Government to increase opioid access for patients with palliative care needs were only marginally successful in raising opioid prescription rates. Opioid access should be improved for patients with palliative care needs who live in geographical areas of lower socioeconomic status.
US National Institutes of Health.
2015 年，墨西哥实施了监管改革和电子系统，以改善处方类阿片类药物的获取途径。我们旨在研究这些改革实施后的阿片类药物配药趋势，并评估阿片类药物配药在地域和社会经济地位方面的差异。
在这项针对处方药物监测数据的回顾性分析中，我们分析了来自墨西哥联邦保护卫生风险委员会数据库的 32 个州和六个大都市区的第 1 组药物（所有阿片类药物，包括吗啡、美沙酮、氢吗啡酮、羟考酮、他喷他多、芬太尼、舒芬太尼和瑞芬太尼）的配药数据。我们计算了全国、州和市各级每 10000 人每年的阿片类药物处方的粗配药率。根据柳叶刀姑息治疗和疼痛缓解委员会报告的方法，我们按州计算了姑息治疗用阿片类药物的需求，然后根据地理位置的社会经济地位评估了实际配药率与预期需求的百分比。在六个主要大都市区内，我们对阿片类药物处方的地理编码位置进行了映射，并评估了阿片类药物配药与社会经济地位之间的关联，以及与位于美墨边境地区的阿片类药物配药与到达美国边境时间之间的关联。
2015 年 6 月 25 日至 2019 年 10 月 7 日期间，每季度（3 个月）阿片类药物的配药率平均增加 13%（95%CI 6.8-19.6）。研究期间全国的阿片类药物总体配药率为每 10000 居民 26.3 份处方。社会经济地位较高的州的阿片类药物配药率高于社会经济地位较低的州（调整后比值比 [RR] 1.88，95%CI 1.33-2.58，p=0.00016），这是在控制了各州每单位的阿片类药物需求、美沙酮诊所的存在情况以及三级医院和癌症中心的存在情况后得出的结果。在大都市地区也观察到了阿片类药物配药与社会经济地位之间的这种关联，在位于美墨边境的大都市地区，到达边境的旅行时间每增加一个标准差（SD 17.1 分钟），阿片类药物配药就会减少 20%（RR 0.80，95%CI 0.75-0.86）。
墨西哥联邦政府为增加有姑息治疗需求的患者的阿片类药物获取途径而采取的措施，仅略微提高了阿片类药物处方率。应改善有姑息治疗需求且居住在社会经济地位较低地区的患者的阿片类药物获取途径。
美国国立卫生研究院。
