Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia.
Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia.
Int J Drug Policy. 2023 Jul;117:104053. doi: 10.1016/j.drugpo.2023.104053. Epub 2023 May 18.
Australian prescription drug monitoring programs (PDMPs) provide information about a patient's recent medication history for controlled drugs at the point of prescribing and dispensing. Despite their increasing use, the evidence for PDMPs is mixed, and is almost exclusively from the United States. This study examined the impact of PDMP implementation on opioid prescribing among general practitioners in Victoria, Australia.
We examined data on analgesic prescribing using electronic records of 464 medical practices in the Australian state of Victoria between 01/04/2017 and 31/12/ 2020. We used interrupted time series analyses, to examine immediate and longer-term trends in medication prescribing following voluntary (from April 2019) and mandatory PDMP implementation (from April 2020). We examined changes in three outcomes (i) 'high' opioid dose (50-100mg oral morphine equivalent daily dose (OMEDD) and over 100mg (OMEDD) prescribing (ii) prescribing of high-risk medication combinations (opioids with either benzodiazepines or pregabalin), and (iii) initiation of non-controlled pain medications (tricyclic antidepressants, pregabalin and tramadol).
We found no effect of voluntary or mandatory PDMP implementation on 'high-dose' opioid prescribing with reductions only seen in those prescribed <20mg OMEDD (i.e., the lowest dose category). Co-prescribing of opioids with benzodiazepines (additional 11.87 [95%CI 2.04 to 21.67] patients/10,000 and pregabalin (additional 3.54 [95% CI 0.82 to 6.26] patients/10,000 increased following mandatory PDMP implementation among those prescribed opioids. In contrast to trends of reduced initiation prior to PDMP implementation, we found increased new initiation of non-monitored medications following PDMP implementation (e.g., an immediate increase of 2.32 [95%CI 0.02 to 4.54], patients/10,000 received pregabalin and 3.06 [95%CI 0.54 to 5.5] patients/10,000 received tricyclic antidepressants after mandatory PDMP implementation), and increased tramadol initiation during the voluntary PDMP period (an increase of 11.26 [95%CI: 5.84, 16.67] patients /10,000).
PDMP implementation did not appear to reduce prescribing of high opioid doses or high-risk combinations. Increased initiation of tricyclic antidepressants, pregabalin and tramadol may indicate a possible unintended effect.
澳大利亚的处方药物监测计划（PDMP）在开具和配药时提供有关患者近期控药用药史的信息。尽管 PDMP 的使用越来越多，但相关证据喜忧参半，而且几乎完全来自美国。本研究调查了 PDMP 的实施对澳大利亚维多利亚州全科医生开具阿片类药物处方的影响。
我们使用澳大利亚维多利亚州 464 家医疗实践的电子病历，于 2017 年 4 月 1 日至 2020 年 12 月 31 日期间，分析了镇痛药物的开具情况。我们使用中断时间序列分析，考察了在自愿（自 2019 年 4 月开始）和强制性 PDMP 实施（自 2020 年 4 月开始）后，药物开具的即时和长期趋势。我们考察了三个结果的变化：（i）“高”阿片类药物剂量（50-100mg 口服吗啡当量日剂量（OMEDD）及以上 100mg（OMEDD）开具处方），（ii）高风险药物组合（阿片类药物与苯二氮䓬类或普瑞巴林）开具处方）和（iii）非受控疼痛药物（三环类抗抑郁药、普瑞巴林和曲马多）的起始。
我们发现自愿或强制性 PDMP 实施均未对“高剂量”阿片类药物的开具产生影响，仅在开具 <20mg OMEDD（即最低剂量类别）的患者中观察到减少。在开具阿片类药物的患者中，普瑞巴林（额外增加 11.87 [95%CI 2.04 至 21.67] 例/10000 人）和苯二氮䓬类药物（额外增加 3.54 [95%CI 0.82 至 6.26] 例/10000 人）的联合处方增加。与 PDMP 实施前开具减少的趋势相反，我们发现 PDMP 实施后非监测药物的新处方增加（例如，立即增加 2.32 [95%CI 0.02 至 4.54] 例/10000 人接受普瑞巴林，3.06 [95%CI 0.54 至 5.5] 例/10000 人接受三环类抗抑郁药），以及自愿 PDMP 期间曲马多的开具增加（增加 11.26 [95%CI：5.84，16.67] 例/10000 人）。
PDMP 的实施似乎并未减少高阿片类药物剂量或高风险组合的开具。三环类抗抑郁药、普瑞巴林和曲马多的新处方的增加可能表明存在可能的意外影响。
