Eidbo Sarah A, Kropp Lopez Amalie K, Hagedorn Joseph D, Mathew Varkey, Kaufman Daniel E, Nichols Stephanie D, McCall Kenneth L, Piper Brian J
Geisinger Commonwealth School of Medicine, Scranton, PA, United States.
University of New England, Portland, ME, United States.
Pain. 2022 Jun 1;163(6):1186-1192. doi: 10.1097/j.pain.0000000000002473. Epub 2021 Sep 9.
The United States is enduring a preventable opioid crisis, particularly involving a population being treated in a hospital setting, a subset of whom may escalate to illicit opioids. This project analyzed trends in distribution of opioids by hospitals in the United States. Opioids monitored included buprenorphine, codeine, fentanyl, hydrocodone, hydromorphone, meperidine, methadone, morphine, oxycodone, oxymorphone, powdered opium, remifentanil, and tapentadol. The Automation of Reports and Consolidated Orders System (ARCOS) reports on substances controlled by the Drug Enforcement Administration. National data from ARCOS reports 5 and 7 from 2000 to 2019 were used for an observational study on hospital opioid distribution. Morphine milligram equivalents (MMEs) were calculated using oral conversion factors. The MME per person per state was calculated to compare data from the peak year, 2012, with data from 2019. Opioid use peaked in 2012, with a -46.6% decline from 2012 to 2019. Half (25) of the states have seen a decrease of -50% or greater. Of the opioid compounds observed, buprenorphine has seen increased (+122.5%) hospital use from 2012 to 2019. All other opioids have been experiencing a decline (≥50%), particularly hydromorphone (-49.9%), oxymorphone (-57.7%), methadone (-58.7%), morphine (-66.9%), codeine (-67.5%), and meperidine (-77.6%). There was a 6-fold difference in population-corrected use of opioids in 2019 between the lowest (6.8 MME/person in New Jersey) and highest (Alaska = 39.6) states. This study demonstrates the considerable progress made thus far by hospitals in curbing the U.S. opioid crisis.
美国正遭受一场本可预防的阿片类药物危机，尤其是在医院环境中接受治疗的人群，其中一部分人可能会升级使用非法阿片类药物。该项目分析了美国医院阿片类药物的分发趋势。监测的阿片类药物包括丁丙诺啡、可待因、芬太尼、氢可酮、氢吗啡酮、哌替啶、美沙酮、吗啡、羟考酮、奥施康定、阿片粉、瑞芬太尼和曲马多。报告与综合订单系统（ARCOS）报告了美国缉毒局管控物质的情况。利用2000年至2019年ARCOS报告5和7中的全国数据进行了一项关于医院阿片类药物分发的观察性研究。使用口服换算系数计算吗啡毫克当量（MME）。计算了每个州每人的MME，以便将2012年（峰值年份）的数据与2019年的数据进行比较。阿片类药物的使用在2012年达到峰值，从2012年到2019年下降了46.6%。一半（25个）州的降幅达到或超过了50%。在所观察的阿片类化合物中，丁丙诺啡在2012年至2019年期间医院使用量增加了122.5%。所有其他阿片类药物的使用量都在下降（≥50%），尤其是氢吗啡酮（49.9%）、奥施康定（57.7%）、美沙酮（58.7%）、吗啡（66.9%）、可待因（67.5%）和哌替啶（77.6%）。2019年，在使用阿片类药物的人口校正量方面，最低的州（新泽西州为每人6.8 MME）和最高的州（阿拉斯加州为39.6）之间存在6倍的差异。这项研究表明，医院在遏制美国阿片类药物危机方面迄今已取得了相当大的进展。
