The effects of a provincial opioid prescribing standard on prescribing for pain in adults: an interrupted time-series analysis.

IF 9.4 1区医学 Q1 MEDICINE, GENERAL & INTERNAL

Canadian Medical Association journal Pub Date : 2025-05-11 DOI:10.1503/cmaj.250167

Dimitra Panagiotoglou, Sandra Peterson, M Ruth Lavergne, Tara Gomes, Rashmi Chadha, Philippa Hawley, Rita McCracken

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引用次数: 0

Abstract

Background: In 2016, the College of Physicians and Surgeons of British Columbia released a legally enforceable opioid prescribing practice standard for the treatment of chronic noncancer pain (CNCP); it was revised in 2018 in response to concerns that it was misinterpreted. We aimed to test the effects of the practice standard on access to opioids for people treated for CNCP, living with cancer, or receiving palliative care.

Methods: We used comprehensive administrative health data from Oct. 1, 2012, to Mar. 31, 2020, and multiple baseline interrupted time-series analysis to evaluate the effects of the 2016 practice standard and 2018 revision in cohorts of people treated for CNCP, living with cancer, or receiving palliative care.

Results: The 2016 practice standard accelerated pre-existing monthly trends in morphine milligram equivalents (MME) dispensed per person treated for CNCP (-0.1%, 95% confidence interval [CI] -0.2% to 0.0%), but also for people living with cancer (-0.7%, 95% CI -1.0% to -0.5%) and those receiving palliative care (-0.3%, 95% CI -0.5% to 0.0%). The proportion of people with CNCP prescribed a daily dose greater than 90 MME (-0.3%, 95% CI -0.4% to -0.2%), coprescribed a benzodiazepine or other hypnotic (-0.6%, 95% CI -0.7% to -0.5%), and aggressively tapered (-0.1%, 95% CI -0.2% to 0.0%) also decreased more quickly after the practice standard. Although we observed null or decreases in level effects overall, the proportion of people aggressively tapered increased 2.0% (95% CI 0.4% to 3.3%) immediately after implementation of the practice standard. Trends slowed or reversed after the 2018 revision.

Interpretation: The 2016 practice standard was associated with an immediate and long-lasting effect on physicians' opioid prescribing behaviours, including inadvertently increasing aggressive tapering (observed level effect) and reducing access to opioids for people living with cancer or receiving palliative care.

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省级阿片类药物处方标准对成人疼痛处方的影响：中断时间序列分析。

背景：2016年，不列颠哥伦比亚省内科医生和外科医生学院发布了一项用于治疗慢性非癌性疼痛（CNCP）的具有法律约束力的阿片类药物处方实践标准；该法案于2018年进行了修订，以回应人们对其被误解的担忧。我们的目的是测试实践标准对接受CNCP治疗、癌症患者或接受姑息治疗的患者获得阿片类药物的影响。方法：我们使用2012年10月1日至2020年3月31日的综合行政健康数据，并进行多基线中断时间序列分析，以评估2016年实践标准和2018年修订对CNCP治疗、癌症患者或接受姑息治疗的人群的影响。结果：2016年实践标准加速了CNCP治疗中每人分配的吗啡毫克当量（MME）的预先存在的月度趋势（-0.1%，95%置信区间[CI] -0.2%至0.0%），但也适用于癌症患者（-0.7%,95% CI -1.0%至-0.5%）和接受缓和治疗的患者（-0.3%,95% CI -0.5%至0.0%）。服用每日剂量大于90 MME （-0.3%, 95% CI -0.4%至-0.2%）、同时服用苯二氮卓类药物或其他催眠药物（-0.6%,95% CI -0.7%至-0.5%）和积极逐渐减少（-0.1%,95% CI -0.2%至0.0%）的CNCP患者比例在实践标准后也下降得更快。虽然我们观察到总体水平效应为零或下降，但在实施实践标准后，积极逐渐减少的人群比例立即增加了2.0% （95% CI 0.4%至3.3%）。2018年修订后，趋势放缓或逆转。解释：2016年实践标准对医生的阿片类药物处方行为产生了直接和持久的影响，包括无意中增加了积极的逐渐减少（观察到的水平效应），减少了癌症患者或接受姑息治疗的人获得阿片类药物的机会。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Canadian Medical Association journal 医学-医学：内科

CiteScore

8.30

自引率

4.10%

发文量

481

审稿时长

4-8 weeks

期刊介绍： CMAJ (Canadian Medical Association Journal) is a peer-reviewed general medical journal renowned for publishing original research, commentaries, analyses, reviews, clinical practice updates, and editorials. Led by Editor-in-Chief Dr. Kirsten Patrick, it has a significant impact on healthcare in Canada and globally, with a 2022 impact factor of 17.4. Its mission is to promote knowledge vital for the health of Canadians and the global community, guided by values of service, evidence, and integrity. The journal's vision emphasizes the importance of the best evidence, practice, and health outcomes. CMAJ covers a broad range of topics, focusing on contributing to the evidence base, influencing clinical practice, and raising awareness of pressing health issues among policymakers and the public. Since 2020, with the appointment of a Lead of Patient Involvement, CMAJ is committed to integrating patients into its governance and operations, encouraging their content submissions.