2014年氢可酮重新分类后向美国毒物控制中心报告的氢可酮滥用暴露情况的变化。
Changes in Hydrocodone Misuse Exposures Reported to U.S. Poison Centers Following Rescheduling in 2014.
作者信息
Fischer Laura J, Severtson Stevan G, Gurrola Marie C, Iwanicki Janetta L, Green Jody L, Dart Richard C
机构信息
Rocky Mountain Poison & Drug Safety, Denver Health, Denver, Colorado, USA.
Integrated Behavioral Health, Inflexxion, Irvine, California, USA.
出版信息
Subst Use Misuse. 2022;57(7):1097-1103. doi: 10.1080/10826084.2022.2063898. Epub 2022 Apr 22.
BACKGROUND
In 2014, the Drug Enforcement Administration rescheduled hydrocodone combination products to Schedule II to reduce nonmedical use and diversion.
METHODS
The impact of rescheduling was assessed using quarterly data from 2011 through 2019 from the Researched Abuse, Diversion and Addiction-Related Surveillance (RADARS) System Poison Center Program and IQVIA Longitudinal Prescription Data. Trends and immediate changes in prescriptions dispensed and misuse exposures before and after rescheduling involving hydrocodone, oxycodone, and other Schedule II opioid analgesics were calculated using segmented regression.
RESULTS
Hydrocodone prescriptions were stable pre-rescheduling, decreased by 2.7% (95% CI: -3.6%, -1.8%, < 0.0001) per quarter post-rescheduling. Misuse exposures involving hydrocodone were decreasing by 3.2% (95% CI: -3.9%, -2.4%, < 0.0001) per quarter pre-rescheduling and decreased by 4.9% (95% CI: -5.5%, -4.2%, < 0.0001) post-rescheduling. Immediate decreases in hydrocodone prescriptions and misuse exposure rates in 2014Q4 compared to 2014Q3 were significant and different from oxycodone or other Schedule II opioids. Schedule II opioid analgesics prescriptions in aggregate were stable prior to rescheduling, decreased by 10.8% (95%CI: -14.0%, -7.6%, < 0.0001) immediately after the rescheduling, and decreased by 2.3% per quarter (95% CI: -3.1%, -1.5%, < 0.0001) subsequently. Misuse exposures involving these opioids were decreasing by 3.3% (95% CI: -4.1%, -2.5%, < 0.0001) prior to rescheduling then by 2.8%, (95% CI: -3.4%, -2.2%, < 0.0001) after rescheduling. The immediate change in misuse was not significant.
CONCLUSIONS
Rescheduling corresponded with changes in hydrocodone prescribing and misuse not offset by increases in other Schedule II opioid analgesics. Misuse exposures for hydrocodone and comparators were decreasing prior to rescheduling with little change post-intervention.
背景
2014年，美国缉毒局将氢可酮复方制剂重新列为二类精神药品，以减少非医疗用途和滥用。
方法
利用2011年至2019年每季度来自药物滥用、转移和成瘾相关监测（RADARS）系统中毒控制中心项目以及艾昆纬纵向处方数据，评估重新分类的影响。使用分段回归计算重新分类前后涉及氢可酮、羟考酮和其他二类阿片类镇痛药的处方配药量和滥用暴露量的趋势及即时变化。
结果
重新分类前氢可酮处方稳定，重新分类后每季度减少2.7%（95%置信区间：-3.6%，-1.8%，<0.0001）。重新分类前涉及氢可酮的滥用暴露量每季度下降3.2%（95%置信区间：-3.9%，-2.4%，<0.0001），重新分类后下降4.9%（95%置信区间：-5.5%，-4.2%，<0.0001）。与2014年第三季度相比，2014年第四季度氢可酮处方和滥用暴露率的即时下降显著，且与羟考酮或其他二类阿片类药物不同。二类阿片类镇痛药的处方总量在重新分类前稳定，重新分类后立即下降10.8%（95%置信区间：-14.0%，-7.6%，<0.0001），随后每季度下降2.3%（95%置信区间：-3.1%，-1.5%，<0.0001）。涉及这些阿片类药物的滥用暴露量在重新分类前下降3.3%（95%置信区间：-4.1%，-2.5%），重新分类后下降2.8%（95%置信区间：-3.4%，-2.2%）。滥用的即时变化不显著。
结论
重新分类与氢可酮处方和滥用的变化相关，且未被其他二类阿片类镇痛药的增加所抵消。重新分类前氢可酮及对照药物的滥用暴露量在下降，干预后变化不大。
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