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Abstract：
Opioid misuse is a nationwide issue and is of particular concern with regard to military readiness. The 2017 National Defense Authorization Act charges the Military Health System with greater oversight of opioid use and mitigation of misuse.
We synthesized published articles using secondary analysis of TRICARE claims data, a nationally representative database of 9.6 million beneficiaries. We screened 106 articles for inclusion and identified 17 studies for data abstraction. Framework analysis was conducted, which assessed prescribing practices, patient use, and optimum length of opioid prescriptions after surgery, trauma, and common procedures, as well as factors leading to sustained prescription opioid use.
Across the studies, sustained prescription opioid use after surgery was low overall, with <1% of opioid-naïve patients still receiving opioids more than 1 year after spinal surgery or trauma. In opioid-exposed patients who had undergone spine surgery, sustained use was slightly lower than 10%. Higher rates of sustained use were associated with more severe trauma and depression, as well as with prior use and initial opioid prescriptions for low back pain or other undefined conditions. Black patients were more likely to discontinue opioid use than were White patients.
Prescribing practices are well correlated with degree of injury or intensity of intervention. Sustained prescription opioid use beyond 1 year is rare and is associated with diagnoses for which opioids are not the standard of care. More efficient coding, increased attention to clinical practice guidelines, and use of tools to predict risk of sustained prescription opioid use are recommended.
We synthesized published articles using secondary analysis of TRICARE claims data, a nationally representative database of 9.6 million beneficiaries. We screened 106 articles for inclusion and identified 17 studies for data abstraction. Framework analysis was conducted, which assessed prescribing practices, patient use, and optimum length of opioid prescriptions after surgery, trauma, and common procedures, as well as factors leading to sustained prescription opioid use.
Across the studies, sustained prescription opioid use after surgery was low overall, with <1% of opioid-naïve patients still receiving opioids more than 1 year after spinal surgery or trauma. In opioid-exposed patients who had undergone spine surgery, sustained use was slightly lower than 10%. Higher rates of sustained use were associated with more severe trauma and depression, as well as with prior use and initial opioid prescriptions for low back pain or other undefined conditions. Black patients were more likely to discontinue opioid use than were White patients.
Prescribing practices are well correlated with degree of injury or intensity of intervention. Sustained prescription opioid use beyond 1 year is rare and is associated with diagnoses for which opioids are not the standard of care. More efficient coding, increased attention to clinical practice guidelines, and use of tools to predict risk of sustained prescription opioid use are recommended.
摘要：
背景：阿片类药物滥用是一个全国性的问题，特别关注军事准备。2017年《国防授权法》要求军事卫生系统（MHS）对阿片类药物的使用和减少滥用进行更大的监督。
方法：我们使用对TRICARE索赔数据的二次分析综合了已发表的文章，960万受益人的全国代表性数据库。我们筛选了106份手稿，并确定了17项数据抽象研究。进行了框架分析，评估处方实践，患者使用,以及手术后阿片类药物处方的最佳长度，创伤,和常见的程序，以及导致处方阿片类药物持续使用的因素。
结果：在整个研究中，手术后持续处方阿片类药物的使用总体较低，<1％的未接受阿片类药物的患者在脊柱手术或创伤后1年仍接受阿片类药物治疗。在脊柱手术后暴露于阿片类药物的患者中，持续使用略低于10%。更高的持续使用率与更严重的创伤和抑郁有关，以及先前使用和初始阿片类药物处方用于下腰痛或其他未定义的条件。与白人患者相比，黑人患者更有可能停止使用阿片类药物。
结论：处方实践与损伤程度或干预强度密切相关。超过1年的持续处方阿片类药物使用很少见，并且与阿片类药物不是护理标准的诊断有关。更高效的编码，增加了对临床实践指南的关注，建议使用工具来预测持续处方阿片类药物使用的风险.
方法：我们使用对TRICARE索赔数据的二次分析综合了已发表的文章，960万受益人的全国代表性数据库。我们筛选了106份手稿，并确定了17项数据抽象研究。进行了框架分析，评估处方实践，患者使用,以及手术后阿片类药物处方的最佳长度，创伤,和常见的程序，以及导致处方阿片类药物持续使用的因素。
结果：在整个研究中，手术后持续处方阿片类药物的使用总体较低，<1％的未接受阿片类药物的患者在脊柱手术或创伤后1年仍接受阿片类药物治疗。在脊柱手术后暴露于阿片类药物的患者中，持续使用略低于10%。更高的持续使用率与更严重的创伤和抑郁有关，以及先前使用和初始阿片类药物处方用于下腰痛或其他未定义的条件。与白人患者相比，黑人患者更有可能停止使用阿片类药物。
结论：处方实践与损伤程度或干预强度密切相关。超过1年的持续处方阿片类药物使用很少见，并且与阿片类药物不是护理标准的诊断有关。更高效的编码，增加了对临床实践指南的关注，建议使用工具来预测持续处方阿片类药物使用的风险.
