Department of Pharmaceutical Outcomes & Policy, University of Florida, Gainesville, Florida.
Department of Pharmaceutical Outcomes & Policy, University of Florida, Gainesville, Florida; Center for Drug Evaluation and Safety, University of Florida, Gainesville, Florida.
J Pain. 2023 Nov;24(11):1994-2002. doi: 10.1016/j.jpain.2023.06.008. Epub 2023 Jun 15.
While opioid prescribing has significantly decreased from a peak in 2012, less is known about the national utilization of non-opioid analgesics such as non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen (APAP) in the context of the opioid crisis. The objective of this study is to characterize the prescribing trends of NSAIDs and APAP in the US ambulatory care setting. We conducted repeated cross-sectional analyses using the 2006-2016 National Ambulatory Medical Care Survey. NSAID-involved visits were defined as patient visits among adults in which NSAIDs were ordered, supplied, administered, or continued. We used similarly-defined APAP visits as a referent group for context. After excluding aspirin and other NSAID/APAP combination products containing opioids, we calculated the annual proportion of NSAID-involved visits among all ambulatory visits. We conducted trend analyses using multivariable logistic regression adjusted for years, patient, and prescriber characteristics. From 2006 to 2016, there were 775.7 million NSAID-involved visits and 204.3 million APAP-involved visits. Most NSAIDs-involved visits were from patients aged 46-64 years (39.6%), female (60.4%), White (83.2%), and having commercial insurance (49.0%). There were significant increasing trends for the proportion of NSAID-involved visits (8.1-9.6%) and APAP-involved visits (1.7-2.9%) (both P < .0001). We observed an overall increase in NSAID and APAP-involved visits in US ambulatory care settings from 2006 to 2016. This trend may be attributed to decreasing opioid prescribing and raises safety concerns related to acute or chronic NSAID and APAP use. PERSPECTIVE: This study shows an overall increasing trend in NSAID use reported in nationally representative ambulatory care visits in the United States. This increase coincides with previously reported significant decreases in opioid analgesic use, particularly after 2012. Given the safety concerns related to chronic or acute NSAID use, there is a need to continue monitoring the use trends of this class of medication.
尽管阿片类药物的处方量从 2012 年的峰值显著下降，但在阿片类药物危机的背景下，关于非甾体抗炎药（NSAIDs）和对乙酰氨基酚（APAP）等非阿片类镇痛药在全美门诊环境中的使用情况，人们知之甚少。本研究旨在描述美国门诊环境中 NSAIDs 和 APAP 的处方趋势。我们使用 2006-2016 年全国门诊医疗调查进行了重复横断面分析。涉及 NSAID 的就诊是指在开出、供应、管理或继续使用 NSAIDs 的情况下，对成年患者进行的就诊。我们将类似定义的 APAP 就诊作为参照组。排除含有阿片类药物的阿司匹林和其他 NSAID/APAP 复方产品后，我们计算了所有门诊就诊中涉及 NSAID 的就诊的年比例。我们使用多变量逻辑回归调整了年份、患者和医生特征进行趋势分析。从 2006 年到 2016 年，有 7.757 亿次涉及 NSAID 的就诊和 2.043 亿次涉及 APAP 的就诊。大多数涉及 NSAID 的就诊来自年龄在 46-64 岁的患者（39.6%）、女性（60.4%）、白人（83.2%）和有商业保险的患者（49.0%）。涉及 NSAID 的就诊比例（8.1-9.6%）和涉及 APAP 的就诊比例（1.7-2.9%）均呈显著上升趋势（均 P<.0001）。我们观察到 2006 年至 2016 年期间，美国门诊环境中 NSAID 和 APAP 涉及就诊的总体增加。这种趋势可能归因于阿片类药物处方量的减少，并引起了与 NSAID 和 APAP 急性或慢性使用相关的安全问题。观点：本研究显示，在美国具有代表性的全国门诊就诊中，报告的 NSAID 使用总体呈上升趋势。这一增长与先前报告的阿片类镇痛药使用量显著下降相吻合，尤其是 2012 年以后。鉴于与 NSAID 长期或急性使用相关的安全问题，需要继续监测此类药物的使用趋势。
