Carmona Araújo Ana, Guerreiro José Pedro, Bulhosa Carolina, Alves da Costa Filipa, Goulão João, Martins Ana Paula
Faculty of Pharmacy, iMed.ULisboa - Research Institute for Medicines, University of Lisbon, Lisbon, Portugal.
Centre for Health Evaluation & Research/Infosaúde - National Association of Pharmacies (CEFAR/IS-ANF), Lisbon, Portugal.
J Pharm Policy Pract. 2024 Jul 29;17(1):2369319. doi: 10.1080/20523211.2024.2369319. eCollection 2024.
Although psychoactive medicines (PMed) are needed in several psychiatric conditions, their use and misuse bear risks. We aimed at estimating the prevalence of PMed use and misuse.
Data on all PMed prescribed in 2017 and dispensed in community pharmacies of the Lisbon and Tagus Valley region of Portugal (ARSLVT) were extracted from ARSLVT medicines' dispensing database. For 21 PMed among prescription opioids, benzodiazepines and z-drugs (BZDR), antidepressants (AD) and anticonvulsants (AC), we estimated the number of users of each PMed, and assessed PMed misuse by a set of proxy indicators for studying this practice: chronic use (use of ≥180 DDD during the study period) of PMed intended for short-term treatments, concomitant use of several PMed, in particular if involving long-term (≥ 30 days) opioid analgesic (OA) use, and doctor shopping (patients consulting several physicians in order to have access to a quantity higher than intended by each prescriber). Data were analysed using descriptive statistics and hypothesis testing, and multivariate logistic regression was used to explore potential factors affecting long-term concomitant treatment of chronic OA with other PMed.
PMed use prevalence was 21.7%: 6.6% for OA, 12.7% for benzodiazepines (BZD), 5.3% for AD and 2.8% for AC. BZDR were mainly prescribed in primary care and OA in hospital outpatients. Chronic use of PMed was observed in 25%, especially with sertraline and buprenorphine for opioid use disorder (long-term treatment), and lorazepam (short-term treatment). About 56.6% of OA chronic users were long-term concurrent users with other PMed, mainly BZDR. Risk of abuse was low for BZDR, whilst four opioids had meaningful doctor shopping indicators - fentanyl, opioid use disorder buprenorphine, morphine and hydromorphone.
BZD are the main PMed used in ARSLVT, often chronically, especially lorazepam. Prevalence of OA use is low, although with higher risk of misuse than BZDR. Concomitant use of several PMed is frequent.
尽管在多种精神疾病中都需要使用精神活性药物（PMed），但其使用和滥用存在风险。我们旨在估算PMed的使用和滥用患病率。
从葡萄牙里斯本和塔霍河谷地区（ARSLVT）社区药房的药品调配数据库中提取2017年所有开具并调配的PMed数据。对于处方阿片类药物、苯二氮䓬类药物和Z类药物（BZDR）、抗抑郁药（AD）和抗惊厥药（AC）中的21种PMed，我们估算了每种PMed的使用者数量，并通过一组用于研究这种行为的替代指标评估PMed滥用情况：用于短期治疗的PMed的长期使用（在研究期间使用≥180限定日剂量）、几种PMed的同时使用，特别是如果涉及长期（≥30天）阿片类镇痛药（OA）使用，以及“医生购物”行为（患者咨询多位医生以获取超过每位开方医生预期数量的药物）。使用描述性统计和假设检验对数据进行分析，并使用多变量逻辑回归来探索影响慢性OA与其他PMed长期联合治疗的潜在因素。
PMed的使用患病率为21.7%：OA为6.6%，苯二氮䓬类药物（BZD）为12.7%，AD为5.3%，AC为2.8%。BZDR主要在初级保健中开具，OA主要在医院门诊开具。观察到25%的PMed存在长期使用情况，尤其是舍曲林和用于阿片类药物使用障碍（长期治疗）的丁丙诺啡，以及劳拉西泮（短期治疗）。约56.6%的OA长期使用者是其他PMed的长期联合使用者，主要是BZDR。BZDR的滥用风险较低，而四种阿片类药物有明显的“医生购物”指标——芬太尼、用于阿片类药物使用障碍的丁丙诺啡、吗啡和氢吗啡酮。
BZD是ARSLVT中使用的主要PMed，经常长期使用，尤其是劳拉西泮。OA的使用患病率较低，尽管其滥用风险高于BZDR。几种PMed的联合使用很常见。
