在实施国家阿片类药物处方限制后,产后阿片类药物处方的变化
Carrie E Fry1, Alvin D Jeffery2,3, Manuel Horta1
1Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee.
JAMA health forum
|November 27, 2024
概括
国家阿片类药物处方限制没有显著改变产后阿片类止痛药的处方,无论是输送类型还是患者阿片类药物. 这些发现表明,目前的限制在这个人群中是无效的.
科学领域:
- 公共卫生 公共卫生
- 药理学 药理学是指药理学的学科.
- 产科 产科 产科 产科 产科
背景情况:
- 阿片类药物危机导致国家一级的阿片类药物处方限制,以制止痛药暴露.
- 之前的研究表明,这些限制在其他临床环境中有效性有限.
- 产后阿片类药物使用是令人担忧的,因为可能导致依赖和转移.
研究的目的:
- 评估国家阿片类药物处方限制和30天产后期阿片类药物处方模式之间的关联.
- 根据分娩类型 (阴道与剖腹产) 和患者的阿片类药物素质分析这些关联.
主要方法:
- 用49个美国州的商业索赔数据 (2014-2021) 进行回顾性观察队列研究.
- 采用差异差异,分阶采用估计器来评估产后阿片类药物处方的变化.
- 分析了阿片类止痛药处方,每天的供应和每次输送的吗啡毫克相当量 (MMEs).
主要成果:
- 包括1,572,338例分娩;32.3%是剖腹产,98.4%为未使用过阿片类药物的患者.
- 阿片类药物处方限制与每次输送148.70MME的非显著下降有关.
- 在阿片类药物处方结果中没有观察到统计学意义上的变化,无论输送类型或阿片类药物是什么.
结论:
- 国家阿片类药物处方限制与产后阿片类药物处方没有显著的关联.
- 这些发现与先前的研究一致,研究了这些极限在其他环境中的有限影响.
- 需要进一步的研究来确定在怀孕期间和分娩后使用阿片类药物的有效预防策略.
相关概念视频
Opioid Analgesics: Synthetic and Semisynthetic Opioids
225
Synthetic and semisynthetic opioids are pivotal in pain management and tackling opioid addiction. Semisynthetic opioids, including morphinans (morphine derivatives), oxycodone, oxymorphone, hydrocodone, and hydromorphone, have improved pharmacokinetic profiles compared to morphine. Additionally, heroin and 6-MAM (6-Monoacetylmorphine) show better CNS penetration than morphine due to heightened lipid solubility. Hydromorphone, a potent opioid, undergoes hepatic metabolism to form the active...
225
Opioid Analgesics: Morphine and Other Natural Cogeners
183
Opioids are a class of drugs that mimic endogenous opioid peptides and act on opioid receptors, and help in pain relief. These compounds are classified as natural, synthetic, or semi-synthetic. Natural opioids, like morphine, codeine, and thebaine, are derived from the opium poppy plant (Papaver somniferum or Papaver album) and are termed opiates. Synthetic opioids are artificial, while semi-synthetic opioids combine natural and synthetic compounds. Morphine, a prototypical opioid, possesses a...
183
Analgesia and Pain Management
513
Pain is critical to various clinical pathologies, provoking an urgent need for effective management. Pain, whether acute or chronic, is a complex neurochemical process. Its alleviation depends on the type, with nonopioid analgesics effective for mild to moderate pain, such as musculoskeletal or inflammatory pain, while neuropathic pain responds best to anticonvulsants, tricyclic antidepressants, or serotonin/norepinephrine reuptake inhibitors. For severe acute or chronic pain, opioids may be...
513
Opioid Receptors: Overview
529
Opioid receptors, including the mu (μ, MOR), delta (δ, DOR), and kappa (κ, KOR) types, belong to the rhodopsin family of G protein-coupled receptors. These receptors are located throughout the central and peripheral nervous systems and in non-neuronal tissues such as macrophages and astrocytes. Opioid receptor ligands can be categorized into agonists or antagonists. Highly selective agonists include [d-Ala2, MePhe4, Gly(ol)5]-enkephalin or DAMGO for MOR, [D-Pen2,...
529
Drugs Affecting GI Tract Motility: Opioids as Antidiarrheal Agents
175
Diarrhea, a condition marked by frequent loose or watery bowel movements, can be triggered by multiple factors such as viral or bacterial infections, food intolerances, anxiety, medications, and digestive disorders. Symptoms may include abdominal pain, bloating, nausea, and cramping. Severe or prolonged diarrhea can lead to complications like electrolyte imbalances, malnutrition, and dehydration if left untreated.
Opioids, widely used antidiarrheal agents, mitigate diarrhea by slowing down...
Opioids, widely used antidiarrheal agents, mitigate diarrhea by slowing down...
175
Prescription, Nonprescription and Orphan Drugs
695
Prescription drugs require a prescription from a medical practitioner and can only be obtained from a pharmacy. They have many applications, including treating pain, anxiety, and hypertension.
The misuse and addiction to prescription drugs is a growing problem that can affect people of all age groups, specifically teenagers. This can happen when prescription medications are used in ways not intended by the prescriber, such as taking someone else's prescription or using medication for...
The misuse and addiction to prescription drugs is a growing problem that can affect people of all age groups, specifically teenagers. This can happen when prescription medications are used in ways not intended by the prescriber, such as taking someone else's prescription or using medication for...
695


