PDF(Pubmed)
Abstract：
BACKGROUND: Prescription opioids are widely used for pain control and palliative care but have been associated with a variety of untoward effects, including opioid use disorder, addiction, and increased mortality. Patterns of opioid use in Israel are to date poorly described.
METHODS: Using a community-based database, the authors performed a retrospective analysis of filled opioid prescriptions of Israeli HMO members 18 years of age or older during the years of 2010-2020 that filled at least one opioid prescription. Morphine milligram equivalent (MME) calculations were stratified by presence or absence of oncology diagnosis and by specific opioid medication.
RESULTS: The percentage of HMO members who filled at least one opioid prescription increased every year from 2.1% in 2010 to 4.2% in 2020. There was an increase in the MME per prescription (44.2%), daily MME per capita (142.1%) and MME per prescription-filling patient (39%) from 2010 to 2020. Increased prescription opioid use is driven by a small group of non-oncological patients, which is less than 1.5% of opioid-prescribed patients and 0.1% of the adult population, primarily owing to fentanyl use.
CONCLUSIONS: Supervision and control of opioid prescriptions in Israel should be a focused effort directed at patients prescribed uniquely high dosages rather than a population-wide strategy that focuses on all patients prescribed opioids. This should be complemented by improved physician training and access to non-opioid therapies, as well as improved data collection and analysis.
METHODS: Using a community-based database, the authors performed a retrospective analysis of filled opioid prescriptions of Israeli HMO members 18 years of age or older during the years of 2010-2020 that filled at least one opioid prescription. Morphine milligram equivalent (MME) calculations were stratified by presence or absence of oncology diagnosis and by specific opioid medication.
RESULTS: The percentage of HMO members who filled at least one opioid prescription increased every year from 2.1% in 2010 to 4.2% in 2020. There was an increase in the MME per prescription (44.2%), daily MME per capita (142.1%) and MME per prescription-filling patient (39%) from 2010 to 2020. Increased prescription opioid use is driven by a small group of non-oncological patients, which is less than 1.5% of opioid-prescribed patients and 0.1% of the adult population, primarily owing to fentanyl use.
CONCLUSIONS: Supervision and control of opioid prescriptions in Israel should be a focused effort directed at patients prescribed uniquely high dosages rather than a population-wide strategy that focuses on all patients prescribed opioids. This should be complemented by improved physician training and access to non-opioid therapies, as well as improved data collection and analysis.
摘要：
背景：处方阿片类药物广泛用于疼痛控制和姑息治疗，但与各种不良反应有关，包括阿片类药物使用障碍,上瘾,和死亡率增加。迄今为止，以色列的阿片类药物使用模式描述不佳。
方法：使用基于社区的数据库，作者对2010-2020年期间18岁或以上的以色列HMO成员的阿片类药物处方进行了回顾性分析,这些处方使用了至少一种阿片类药物处方.通过存在或不存在肿瘤学诊断和特定的阿片类药物对吗啡毫克当量（MME）计算进行分层。
结果：填写至少一种阿片类药物处方的HMO成员的百分比每年从2010年的2.1％增加到2020年的4.2％。每个处方的MME增加了（44.2％），从2010年到2020年，人均每日MME（142.1%）和每位处方配药患者的MME（39%）。处方阿片类药物使用的增加是由一小群非肿瘤患者驱动的，不到1.5%的阿片类药物处方患者和0.1%的成年人，主要是由于芬太尼的使用。
结论：以色列阿片类药物处方的监督和控制应该是针对患者的重点工作，而不是针对所有患者的阿片类药物处方。这应该辅之以改进的医生培训和获得非阿片类药物治疗，以及改进的数据收集和分析。
方法：使用基于社区的数据库，作者对2010-2020年期间18岁或以上的以色列HMO成员的阿片类药物处方进行了回顾性分析,这些处方使用了至少一种阿片类药物处方.通过存在或不存在肿瘤学诊断和特定的阿片类药物对吗啡毫克当量（MME）计算进行分层。
结果：填写至少一种阿片类药物处方的HMO成员的百分比每年从2010年的2.1％增加到2020年的4.2％。每个处方的MME增加了（44.2％），从2010年到2020年，人均每日MME（142.1%）和每位处方配药患者的MME（39%）。处方阿片类药物使用的增加是由一小群非肿瘤患者驱动的，不到1.5%的阿片类药物处方患者和0.1%的成年人，主要是由于芬太尼的使用。
结论：以色列阿片类药物处方的监督和控制应该是针对患者的重点工作，而不是针对所有患者的阿片类药物处方。这应该辅之以改进的医生培训和获得非阿片类药物治疗，以及改进的数据收集和分析。
