Armbuster Youngeun C, Banas Brian N, Feickert Kristen D, England Stephanie E, Moyer Erik J, Christie Emily L, Chughtai Sana, Giuliani Tanya J, Halden Rolf U, Graham Jove H, McCall Kenneth L, Piper Brian J
Geisinger Commonwealth School of Medicine, Scranton, PA, USA.
Arizona State University, Tempe, AZ, USA.
J Pharm Technol. 2021 Dec;37(6):278-285. doi: 10.1177/87551225211035563. Epub 2021 Jul 30.
Cocaine is a stimulant and Schedule II drug used as a local anesthetic and vasoconstrictor. This descriptive study characterized medical cocaine use in the United States. Retail drug distribution data from 2002 to 2017 were extracted for each state from the Drug Enforcement Administration, which reports on medical, research, and analytical chemistry use. The percentage of buyers (pharmacies, hospitals, and providers) was obtained. Use per state, corrected for population, was determined. Available cross-sectional data on cocaine use as reported by the Medicare and Medicaid programs for 2013-2017 and electronic medical records were examined. Medical cocaine use decreased by -62.5% from 2002 to 2017. Hospitals accounted for 84.9% and practitioners for 9.9% of cocaine distribution in 2017. The number of pharmacies carrying cocaine dropped by -69.4%. The percentages of hospitals, practitioners, and pharmacies that carried cocaine in 2017 were 38.4%, 2.3%, and 0.3%, respectively. There was a 7-fold difference in 2002 (South Dakota, 76.1 mg/100 persons; Delaware, 10.1 mg/100 persons). Relative to the average state in 2017, those reporting the highest values (Montana, 20.1; North Dakota, 24.1 mg/100 persons) were significantly elevated. Cocaine use within the Medicare and Medicaid programs was negligible. Cocaine use within the Geisinger system was rare from 2002 to 2007 (<4 orders/100 000 patients per year) but increased to 48.7 in 2018. If these pharmacoepidemiological patterns continue, licit cocaine may soon become a historical relic. The pharmacology and pharmacotherapeutics education of health care providers may need to be adjusted accordingly.
可卡因是一种兴奋剂，属于二类精神药品，用作局部麻醉剂和血管收缩剂。这项描述性研究对美国医用可卡因的使用情况进行了特征分析。从美国缉毒局提取了2002年至2017年每个州的零售药品分销数据，该机构报告了医用、研究和分析化学用途。获取了购买者（药店、医院和供应商）的百分比。确定了经人口校正后的各州使用量。对医疗保险和医疗补助计划报告的2013 - 2017年可卡因使用情况的现有横断面数据以及电子病历进行了审查。从2002年到2017年，医用可卡因的使用量下降了62.5%。2017年，医院占可卡因分销的84.9%，从业者占9.9%。携带可卡因的药店数量下降了69.4%。2017年，携带可卡因的医院、从业者和药店的百分比分别为38.4%、2.3%和0.3%。2002年存在7倍的差异（南达科他州，76.1毫克/100人；特拉华州，10.1毫克/100人）。相对于2017年的平均州水平，报告最高值的州（蒙大拿州，20.1；北达科他州，24.1毫克/100人）显著升高。医疗保险和医疗补助计划中的可卡因使用量可以忽略不计。2002年至2007年期间，盖辛格系统内的可卡因使用很少（每年<4份处方/10万名患者），但在2018年增加到了48.7份。如果这些药物流行病学模式持续下去，合法可卡因可能很快成为历史遗迹。医疗保健提供者的药理学和药物治疗学教育可能需要相应调整。
