一项省级阿片类药物处方标准对成人疼痛处方的影响：中断时间序列分析。
The effects of a provincial opioid prescribing standard on prescribing for pain in adults: an interrupted time-series analysis.
作者信息
Panagiotoglou Dimitra, Peterson Sandra, Lavergne M Ruth, Gomes Tara, Chadha Rashmi, Hawley Philippa, McCracken Rita
机构信息
Department of Epidemiology, Biostatistics and Occupational Health (Panagiotoglou), McGill University, Montréal, Que.; Centre for Health Services and Policy Research (Peterson), University of British Columbia, Vancouver, BC; Department of Family Medicine, Faculty of Medicine (Lavergne), Dalhousie University, Halifax, NS; Li Ka Shing Knowledge Institute (Gomes), Unity Health; Leslie Dan Faculty of Pharmacy (Gomes), University of Toronto, Toronto, Ont.; Vancouver Coastal Health Authority (Chadha); Department of Family Practice (Chadha, McCracken), University of British Columbia; BC Cancer Vancouver Centre and Division of Palliative Medicine, Department of Medicine (Hawley), University of British Columbia, Vancouver, BC.
出版信息
CMAJ. 2025 May 11;197(18):E497-E505. doi: 10.1503/cmaj.250167.
BACKGROUND
In 2016, the College of Physicians and Surgeons of British Columbia released a legally enforceable opioid prescribing practice standard for the treatment of chronic noncancer pain (CNCP); it was revised in 2018 in response to concerns that it was misinterpreted. We aimed to test the effects of the practice standard on access to opioids for people treated for CNCP, living with cancer, or receiving palliative care.
METHODS
We used comprehensive administrative health data from Oct. 1, 2012, to Mar. 31, 2020, and multiple baseline interrupted time-series analysis to evaluate the effects of the 2016 practice standard and 2018 revision in cohorts of people treated for CNCP, living with cancer, or receiving palliative care.
RESULTS
The 2016 practice standard accelerated pre-existing monthly trends in morphine milligram equivalents (MME) dispensed per person treated for CNCP (-0.1%, 95% confidence interval [CI] -0.2% to 0.0%), but also for people living with cancer (-0.7%, 95% CI -1.0% to -0.5%) and those receiving palliative care (-0.3%, 95% CI -0.5% to 0.0%). The proportion of people with CNCP prescribed a daily dose greater than 90 MME (-0.3%, 95% CI -0.4% to -0.2%), coprescribed a benzodiazepine or other hypnotic (-0.6%, 95% CI -0.7% to -0.5%), and aggressively tapered (-0.1%, 95% CI -0.2% to 0.0%) also decreased more quickly after the practice standard. Although we observed null or decreases in level effects overall, the proportion of people aggressively tapered increased 2.0% (95% CI 0.4% to 3.3%) immediately after implementation of the practice standard. Trends slowed or reversed after the 2018 revision.
INTERPRETATION
The 2016 practice standard was associated with an immediate and long-lasting effect on physicians' opioid prescribing behaviours, including inadvertently increasing aggressive tapering (observed level effect) and reducing access to opioids for people living with cancer or receiving palliative care.
背景
2016年，不列颠哥伦比亚省内科医师和外科医师学院发布了一项具有法律约束力的阿片类药物处方实践标准，用于治疗慢性非癌性疼痛（CNCP）；2018年对其进行了修订，以回应人们对该标准被误解的担忧。我们旨在测试该实践标准对接受CNCP治疗、患有癌症或接受姑息治疗的人群获取阿片类药物的影响。
方法
我们使用了2012年10月1日至2020年3月31日的综合行政健康数据，并采用多基线中断时间序列分析来评估2016年实践标准和2018年修订对接受CNCP治疗、患有癌症或接受姑息治疗人群队列的影响。
结果
2016年的实践标准加速了已有的每人每月吗啡毫克当量（MME）发放量的下降趋势，接受CNCP治疗的人群下降了0.1%（95%置信区间[CI]为-0.2%至0.0%），癌症患者下降了0.7%（95%CI为-1.0%至-0.5%），接受姑息治疗的人群下降了0.3%（95%CI为-0.5%至0.0%）。接受CNCP治疗且每日剂量超过90 MME的人群比例下降了0.3%（95%CI为-0.4%至-0.2%），同时开具苯二氮䓬类药物或其他催眠药的比例下降了0.6%（95%CI为-0.7%至-0.5%），积极减量的比例下降了0.1%（95%CI为-0.2%至0.0%），这些在实践标准发布后下降得也更快。尽管总体上我们观察到水平效应为零或下降，但在实践标准实施后，积极减量的人群比例立即增加了2.0%（95%CI为0.4%至3.3%）。2018年修订后趋势放缓或逆转。
解读
2016年的实践标准对医生的阿片类药物处方行为产生了即时且持久的影响，包括无意中增加了积极减量（观察到的水平效应），并减少了癌症患者或接受姑息治疗人群获取阿片类药物的机会。
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