州级阿片类药物处方限制与手术患者术后持续性阿片类药物使用发生率之间的关联。
Association Between State Limits on Opioid Prescribing and the Incidence of Persistent Postoperative Opioid Use Among Surgical Patients.
机构信息
Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA.
Department of Surgery, University of Michigan Medical School, Ann Arbor, MI.
出版信息
Ann Surg. 2023 Apr 1;277(4):e759-e765. doi: 10.1097/SLA.0000000000005283. Epub 2021 Nov 9.
OBJECTIVE
To examine whether laws limiting opioid prescribing have been associated with reductions in the incidence of persistent postoperative opioid use.
SUMMARY OF BACKGROUND DATA
In an effort to address the opioid epidemic, 26 states (as of 2018) have passed laws limiting opioid prescribing for acute pain. However, it is unknown whether these laws have achieved their reduced the risk of persistent postoperative opioid use.
METHODS
We identified 957,639 privately insured patients undergoing one of 10 procedures between January 1, 2004 and September 30, 2018. We then estimated the association between persistent postoperative opioid use, defined as having filled ≥10 prescriptions or ≥120 days supply of opioids during postoperative days 91-365, and whether opioid prescribing limits were in effect on the day of surgery. States were classified as having: no limits, a limit of ≤7 days supply, or a limit of >7 days supply. The regression models adjusted for observable confounders such as patient comorbidities and also utilized a difference-in-differences approach, which relied on variation in state laws over time, to further minimize confounding.
RESULTS
The adjusted incidence of persistent postoperative opioid use was 3.5% (95%CI 3.3%-3.7%) for patients facing a limit of ≤7 days supply, compared with 3.3% (95%CI 3.3%-3.3%) for patients facing no prescribing limits ( P = 0.13 for difference compared to no prescribing limits) and 3.4%, (95%CI 3.2%-3.6%) for patients facing a limit of >7 days supply ( P = 0.43 for difference compared to no prescribing limits).
CONCLUSIONS
Laws limiting opioid prescriptions were not associated with subsequent reductions in persistent postoperative opioid use.
目的
研究限制阿片类药物处方的法律是否与减少持续性术后阿片类药物使用的发生率有关。
背景资料概要
为了解决阿片类药物泛滥问题，截至 2018 年，已有 26 个州通过了限制急性疼痛阿片类药物处方的法律。然而，这些法律是否降低了持续性术后阿片类药物使用的风险尚不清楚。
方法
我们确定了 957639 名在 2004 年 1 月 1 日至 2018 年 9 月 30 日期间接受 10 种手术之一的私人保险患者。然后，我们估计了持续性术后阿片类药物使用（定义为在术后第 91-365 天期间至少有 10 张处方或 120 天以上的阿片类药物供应）与手术当天是否存在阿片类药物处方限制之间的关联。将各州分为无限制、≤7 天供应量限制或>7 天供应量限制。回归模型调整了患者合并症等可观察到的混杂因素，同时还利用了差异中的差异方法，该方法依赖于州法律随时间的变化，进一步最小化混杂因素。
结果
在面临≤7 天供应量限制的患者中，调整后的持续性术后阿片类药物使用发生率为 3.5%（95%CI 3.3%-3.7%），而在面临无处方限制的患者中为 3.3%（95%CI 3.3%-3.3%）（与无处方限制相比，P=0.13），在面临>7 天供应量限制的患者中为 3.4%（95%CI 3.2%-3.6%）（与无处方限制相比，P=0.43）。
结论
限制阿片类药物处方的法律与随后持续性术后阿片类药物使用的减少无关。
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