Center for Opioid Epidemiology and Policy, Department of Population Health, New York University Grossman School of Medicine, New York.
Department of Population Health, New York University Grossman School of Medicine, New York.
JAMA Pediatr. 2021 Oct 1;175(10):1043-1052. doi: 10.1001/jamapediatrics.2021.1832.
Prescription opioids are involved in more than half of opioid overdoses among younger persons. Understanding opioid prescribing practices is essential for developing appropriate interventions for this population.
To examine temporal trends in opioid prescribing practices in children, adolescents, and younger adults in the US from 2006 to 2018.
DESIGN, SETTING, AND PARTICIPANTS: A population-based, cross-sectional analysis of opioid prescription data was conducted from January 1, 2006, to December 31, 2018. Longitudinal data on retail pharmacy-dispensed opioids for patients younger than 25 years were used in the analysis. Data analysis was performed from December 26, 2019, to July 8, 2020.
Opioid dispensing rate, mean amount of opioid dispensed in morphine milligram equivalents (MME) per day (individuals aged 15-24 years) or MME per kilogram per day (age <15 years), duration of prescription (mean, short [≤3 days], and long [≥30 days] duration), high-dosage prescriptions, and extended-release or long-acting (ER/LA) formulation prescriptions. Outcomes were calculated for age groups: 0 to 5, 6 to 9, 10 to 14, 15 to 19, and 20 to 24 years. Joinpoint regression was used to examine opioid prescribing trends.
From 2006 to 2018, the opioid dispensing rate for patients younger than 25 years decreased from 14.28 to 6.45, with an annual decrease of 15.15% (95% CI, -17.26% to -12.99%) from 2013 to 2018. The mean amount of opioids dispensed and rates of short-duration and high-dosage prescriptions decreased for all age groups older than 5 years, with the largest decreases in individuals aged 15 to 24 years. Mean duration per prescription increased initially for all ages, but then decreased for individuals aged 10 years or older. The duration remained longer than 5 days across all ages. The rate of long-duration prescriptions increased for all age groups younger than 15 years and initially increased, but then decreased after 2014 for individuals aged 15 to 24 years. For children aged 0 to 5 years dispensed an opioid, annual increases from 2011 to 2014 were noted for the mean amount of opioids dispensed (annual percent change [APC], 10.58%; 95% CI, 1.77% to 20.16%) and rates of long-duration (APC, 30.42%; 95% CI, 14.13% to 49.03%), high-dosage (APC, 31.27%; 95% CI, 16.81% to 47.53%), and ER/LA formulation (APC, 27.86%; 95% CI, 12.04% to 45.91%) prescriptions, although the mean amount dispensed and rate of high-dosage prescriptions decreased from 2014 to 2018.
These findings suggest that opioid dispensing rates decreased for patients younger than 25 years, with decreasing rates of high-dosage and long-duration prescriptions for adolescents and younger adults. However, opioids remain readily dispensed, and possible high-risk prescribing practices appear to be common, especially in younger children.
处方类阿片药物在年轻人的阿片类药物过量中占半数以上。了解阿片类药物的开具情况对于为这一人群制定适当的干预措施至关重要。
分析美国儿童、青少年和年轻成年人从 2006 年至 2018 年的阿片类药物开具情况的时间趋势。
设计、地点和参与者：对 2006 年 1 月 1 日至 2018 年 12 月 31 日的阿片类药物处方数据进行了基于人群的横断面分析。分析中使用了 25 岁以下患者零售药店配药的阿片类药物的纵向数据。数据分析于 2019 年 12 月 26 日至 2020 年 7 月 8 日进行。
阿片类药物配药率、每日吗啡毫克当量（MME）的阿片类药物平均用量（15-24 岁个体）或每公斤每日 MME（<15 岁）、处方持续时间（平均、短期[≤3 天]和长期[≥30 天]）、高剂量处方和延长释放或长效（ER/LA）制剂处方。根据年龄组计算了结果：0 至 5 岁、6 至 9 岁、10 至 14 岁、15 至 19 岁和 20 至 24 岁。使用 Joinpoint 回归分析阿片类药物开具趋势。
从 2006 年至 2018 年，25 岁以下患者的阿片类药物配药率从 14.28 降至 6.45，2013 年至 2018 年的年降幅为 15.15%（95%CI，-17.26%至-12.99%）。所有年龄组的阿片类药物用量和短期、高剂量处方的比例均有所下降，15 至 24 岁个体的降幅最大。每个处方的平均持续时间最初有所增加，但随后在 10 岁以上个体中下降。持续时间仍长于 5 天，所有年龄组均如此。15 岁以下所有年龄组的长期处方比例增加，而 15 至 24 岁个体的比例在 2014 年之后先增加后下降。0 至 5 岁接受阿片类药物治疗的儿童，2011 年至 2014 年，阿片类药物的平均用量（每年百分比变化[APC]，10.58%；95%CI，1.77%至 20.16%）和长持续时间（APC，30.42%；95%CI，14.13%至 49.03%）、高剂量（APC，31.27%；95%CI，16.81%至 47.53%）和 ER/LA 制剂（APC，27.86%；95%CI，12.04%至 45.91%）处方的比例呈上升趋势，尽管 2014 年至 2018 年阿片类药物的平均用量和高剂量处方的比例有所下降。
这些发现表明，25 岁以下患者的阿片类药物配药率下降，青少年和年轻成年人的高剂量和长期处方比例下降。然而，阿片类药物仍大量配给，可能存在高风险的开具处方情况，尤其是在年幼的儿童中。
