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Ann Intern Med:处方阿片类药物的过量使用现象仍在继续

2015-12-29 sunshine MedSci原创

据发表于Annals of Internal Medicine的一项新的研究显示,超过90%的慢性疼痛患者会在过量服用阿片类药物后仍继续接受处方阿片类药物治疗,使得他们处于过量服用阿片类药物的风险之中。

据发表于Annals of Internal Medicine的一项新的研究显示,超过90%的慢性疼痛患者会在过量服用阿片类药物后仍继续接受处方阿片类药物治疗,使得他们处于过量服用阿片类药物的风险之中。

阿片类药物的滥用和成瘾,如吗啡、海洛因以及止痛药,是影响机体健康、社会和全球经济的一个严重的问题。

据估计,全球范围内共有 260-360万人滥用阿片类药物。2012年,美国大约有210万患有与处方阿片类止痛药有关的精神障碍性疾病,约46.7万对海洛因成瘾。

美国自1999年以来,因处方止痛药过量使用而致死亡的人数翻了四倍多,且越来越多的研究表明,阿片类镇痛药非医疗使用的增加与海洛因滥用有关。

如果患者存在致命的阿片类药物过量使用,那么应该设置一个警告标志,还要为患者提供识别并处理精神障碍疾病的机会;但是目前关于药物过量后的治疗方法知之甚少。

研究人员使用来自Optum的数据信息,涉及5000万人,长达12年的数据,确定近3000名患者在使用阿片类药物治疗慢性疼痛时存在非致命性过量的现象。

数据显示,过量服用阿片类药物后,91%的患者继续服用处方阿片类药物。此外,70%的患者从同一医生处获得处方。2年后,继续服用高剂量阿片类药物的患者药物再次过量的可能是阿片类药物过量后停止继续服用的患者的二倍。

该研究强调了医生所面临的挑战:在使用处方类阿片类药物治疗慢性疼痛时,平衡已知的风险与潜在的益处。

该研究似乎可加强开发有助于识别并治疗因阿片类药物使用而发生的精神障碍性疾病和/或药物过量风险的工具的需要。

既往研究提到,目前的问题部分原因是由于在处方数量的急剧增加,因不同的目的而使用药物的社会接受程度的增加,以及制药公司的积极营销。其结果是,一般处方药,尤其是阿片类镇痛药,的使用空间变得更大。

Nora Volkow指出,在美国阿片类止痛药的处方总数已从1991年的7600万左右上升到2013年的近2.07亿。

与此同时,因阿片类镇痛药的非医疗使用而就诊于急救科的患者由2004年的144600名上升至2008年的305900名;因非海洛因阿片类药物滥用而治疗的患者由1997年的1%所有患者上升至2007年的5%;而且,在过去的20年里,因处方阿片类止痛药过量而死亡的患者已经超过了三倍,在2010年达到了16651名。

原始出处:

Yvette Brazier. Opioid prescriptions continue after overdose. MNT, 29 Dec 2015.

Marc R. Larochelle, MD, MPH; Jane M. Liebschutz, MD, MPH; Fang Zhang, PhD; Dennis Ross-Degnan, ScD; and J. Frank Wharam, MB, BCh, BAO, MPH.Opioid Prescribing After Nonfatal Overdose and Association With Repeated Overdose: A Cohort Study,Annals of Internal Medicine, doi:10.7326/M15-0038, published online 29 December 2015

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    2015-12-31 lhlxtx
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    2015-12-30 lu2996

    这种事情无法解决

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=2010974, encodeId=eff020109e4c0, content=<a href='/topic/show?id=fbd14244ee7' target=_blank style='color:#2F92EE;'>#处方阿片类药物#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=105, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=42447, encryptionId=fbd14244ee7, topicName=处方阿片类药物)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8f14236, createdName=经常头晕, createdTime=Sat Apr 09 05:39:00 CST 2016, time=2016-04-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1252996, encodeId=ffe912529963f, content=<a href='/topic/show?id=13159e8871d' target=_blank style='color:#2F92EE;'>#阿片类药物#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97887, encryptionId=13159e8871d, topicName=阿片类药物)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c83329, createdName=10518093zz, createdTime=Thu Dec 31 09:39:00 CST 2015, time=2015-12-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1309008, encodeId=884113090086a, content=<a href='/topic/show?id=a0179e879ac' target=_blank style='color:#2F92EE;'>#阿片类#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=117, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97879, encryptionId=a0179e879ac, topicName=阿片类)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7e12358, createdName=lhlxtx, createdTime=Thu Dec 31 09:39:00 CST 2015, time=2015-12-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1606789, encodeId=bf521606e890d, content=<a href='/topic/show?id=eb6b1145939' target=_blank style='color:#2F92EE;'>#Med#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11459, encryptionId=eb6b1145939, topicName=Med)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=552a19396740, createdName=ms3994565386320060, createdTime=Thu Dec 31 09:39:00 CST 2015, time=2015-12-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=50517, encodeId=5ccb5051e37, content=这种事情无法解决, beContent=null, objectType=article, channel=null, level=null, likeNumber=158, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c1b91651063, createdName=lu2996, createdTime=Wed Dec 30 14:08:00 CST 2015, time=2015-12-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=50518, encodeId=1605505186e, content=全球问题, beContent=null, objectType=article, channel=null, level=null, likeNumber=193, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c1b91651063, createdName=lu2996, createdTime=Wed Dec 30 14:08:00 CST 2015, time=2015-12-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=50519, encodeId=1ffa5051935, content=无法简单解决, beContent=null, objectType=article, channel=null, level=null, likeNumber=171, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c1b91651063, createdName=lu2996, createdTime=Wed Dec 30 14:08:00 CST 2015, time=2015-12-30, status=1, ipAttribution=)]
    2015-12-30 lu2996

    全球问题

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=2010974, encodeId=eff020109e4c0, content=<a href='/topic/show?id=fbd14244ee7' target=_blank style='color:#2F92EE;'>#处方阿片类药物#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=105, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=42447, encryptionId=fbd14244ee7, topicName=处方阿片类药物)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8f14236, createdName=经常头晕, createdTime=Sat Apr 09 05:39:00 CST 2016, time=2016-04-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1252996, encodeId=ffe912529963f, content=<a href='/topic/show?id=13159e8871d' target=_blank style='color:#2F92EE;'>#阿片类药物#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97887, encryptionId=13159e8871d, topicName=阿片类药物)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c83329, createdName=10518093zz, createdTime=Thu Dec 31 09:39:00 CST 2015, time=2015-12-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1309008, encodeId=884113090086a, content=<a href='/topic/show?id=a0179e879ac' target=_blank style='color:#2F92EE;'>#阿片类#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=117, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97879, encryptionId=a0179e879ac, topicName=阿片类)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7e12358, createdName=lhlxtx, createdTime=Thu Dec 31 09:39:00 CST 2015, time=2015-12-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1606789, encodeId=bf521606e890d, content=<a href='/topic/show?id=eb6b1145939' target=_blank style='color:#2F92EE;'>#Med#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11459, encryptionId=eb6b1145939, topicName=Med)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=552a19396740, createdName=ms3994565386320060, createdTime=Thu Dec 31 09:39:00 CST 2015, time=2015-12-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=50517, encodeId=5ccb5051e37, content=这种事情无法解决, beContent=null, objectType=article, channel=null, level=null, likeNumber=158, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c1b91651063, createdName=lu2996, createdTime=Wed Dec 30 14:08:00 CST 2015, time=2015-12-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=50518, encodeId=1605505186e, content=全球问题, beContent=null, objectType=article, channel=null, level=null, likeNumber=193, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c1b91651063, createdName=lu2996, createdTime=Wed Dec 30 14:08:00 CST 2015, time=2015-12-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=50519, encodeId=1ffa5051935, content=无法简单解决, beContent=null, objectType=article, channel=null, level=null, likeNumber=171, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c1b91651063, createdName=lu2996, createdTime=Wed Dec 30 14:08:00 CST 2015, time=2015-12-30, status=1, ipAttribution=)]
    2015-12-30 lu2996

    无法简单解决

    0

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