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首页> 外文期刊>Substance Abuse Treatment, Prevention, and Policy >Patterns, trends and determinants of medical opioid utilization in Canada 2005–2020: characterizing an era of intensive rise and fall
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Patterns, trends and determinants of medical opioid utilization in Canada 2005–2020: characterizing an era of intensive rise and fall

机译：2005 - 2020年加拿大医疗阿片利用的模式，趋势和决定因素：表征集密集型升降的时代

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Into the 21st century, the conflation of high rates of chronic pain, systemic gaps in treatment availability and access, and the arrival of potent new opioid medications (e.g., slow-release oxycodone) facilitated strong increases in medical opioid dispensing in Canada. These persisted until post-2010 alongside rising opioid-related adverse (e.g., morbidity/mortality) outcomes. We examine patterns, trends and determinants of opioid dispensing in Canada, and specifically its 10 provinces, for the years 2005–2020. Raw data on prescription opioid dispensing were obtained from a large national community-based pharmacy database (IQVIA/Compuscript), converted into Defined-Daily-Doses/1,000 population/day for ‘strong’ and ‘weak’ opioid categories per standard methods. Dispensing by opioid category and formulations by province/year was assessed descriptively; regression analysis was applied to examine possible segmentation of over-time strong opioid dispensing. All provinces reported starkly increasing strong opioid dispensing peaking 2011–2016, and subsequent marked declines. About half reported lower strong opioid dispensing in 2020 compared to 2005, with continuous inter-provincial differences of ?100?%; weak opioids also declined post-2011/12. Segmented regression suggests breakpoints for strong opioids in 2011/12 and 2015/16, coinciding with main interventions (e.g., selective opioid delisting, new prescribing guidelines) towards more restrictive opioid utilization control. We characterized an era of marked rise and fall, while featuring stark inter-provincial heterogeneity in opioid dispensing in Canada. While little evidence for improvements in pain care outcomes exists, the starkly inverting opioid utilization have been associated with extensive population-level harms (e.g., misuse, morbidity, mortality) over-time. This national case study raises fundamental questions for opioid-related health policy and practice.
机译：进入21世纪，慢性疼痛高率的汇集，治疗可用性和通道的系统性差距，以及有效的新阿片类药物（例如，缓释羟考酮）的到来促进了加拿大医疗阿片类药物分配的强劲增加。这些持续到2010年后的表阿片类药物相关的不利（例如，发病率/死亡率）结果。我们研究了加拿大阿片类药物分配的模式，趋势和决定因素，特别是2005 - 2020年的10个省份。处方表阿片类药物的原始数据是从大型国家社区的药房数据库（IQVIA / Compuscript）获得，转换为每次标准方法的“强”和“弱”阿片类药物的定义日常剂量/ 1,000人口/日。通过ApioID类别和省级的配方分配/年度的描述是描述的;应用回归分析来检查可能的过度强大阿片类药物分配的可能分割。所有省份均报告持续增加强大的阿片类药物分配达到峰值2011-2016，随后标志着下降。大约2005年2020年报告的较低的强大阿片类药物分配，连续省级差异，＆ 100？％;薄弱的阿片类药也拒绝了2011年/ 12篇。分段回归表明2011/12和2015/16年度强有力的阿片类药物的断点，与主要干预（例如，选择性阿片类药物销售，新的处方指南）恰逢更严格的阿片类药物利用管制。我们的特色是标记和跌幅的时代，同时在加拿大的阿片类药物分配中具有斯塔克省间异质性。虽然存在痛苦结果的改善的少数证据存在，但持续的阿片类药物利用率与广泛的人口水平危害（例如，滥用，发病，死亡率）相关联。本国案例研究提高了与阿片类药物相关的健康政策和实践的基本问题。

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