精神药物的使用和滥用:在葡萄牙一个人口稠密地区进行的横断面描述性研究。

IF 3.3 Q1 HEALTH POLICY & SERVICES
Journal of Pharmaceutical Policy and Practice Pub Date : 2024-07-29 eCollection Date: 2024-01-01 DOI:10.1080/20523211.2024.2369319
Ana Carmona Araújo, José Pedro Guerreiro, Carolina Bulhosa, Filipa Alves da Costa, João Goulão, Ana Paula Martins
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引用次数: 0

摘要

导言:尽管精神活性药物(PMed)在多种精神疾病中都有必要使用,但其使用和滥用也存在风险。我们旨在估算精神药物使用和滥用的普遍程度:从葡萄牙里斯本和塔古斯河谷地区(ARSLVT)药品配发数据库中提取了2017年葡萄牙里斯本和塔古斯河谷地区社区药房开具和配发的所有PMed数据。对于处方阿片类药物、苯二氮卓类药物和z类药物(BZDR)、抗抑郁药物(AD)和抗惊厥药物(AC)中的21种PMed,我们估算了每种PMed的使用者数量,并通过一组研究这种做法的替代指标评估了PMed的滥用情况:我们估算了每种 PMed 的使用人数,并通过一组用于研究这种做法的替代指标对 PMed 滥用进行了评估:用于短期治疗的 PMed 的长期使用(在研究期间使用量≥180 DDD)、多种 PMed 的同时使用(尤其是涉及阿片类镇痛药(OA)的长期(≥30 天)使用)以及 "择医"(患者向多位医生咨询,以获得高于每位处方医生预期的用药量)。研究采用描述性统计和假设检验对数据进行了分析,并利用多变量逻辑回归探讨了影响长期同时使用其他PMed治疗慢性OA的潜在因素:结果:PMed的使用率为21.7%:结果:PMed的使用率为21.7%:6.6%用于OA,12.7%用于苯二氮卓(BZD),5.3%用于AD,2.8%用于AC。苯二氮卓类药物(BZDR)主要在初级保健中处方,OA则在医院门诊患者中处方。长期使用 PMed 的比例为 25%,尤其是舍曲林和丁丙诺啡,用于治疗阿片类药物使用障碍(长期治疗)和劳拉西泮(短期治疗)。约 56.6%的 OA 长期使用者长期同时使用其他 PMed,主要是 BZDR。BZDR的滥用风险较低,而四种阿片类药物则有意义的医生购物指标--芬太尼、阿片类药物使用障碍丁丙诺啡、吗啡和氢吗啡酮:BZD是ARSLVT患者使用的主要PMed,通常是长期使用,尤其是劳拉西泮。OA 的使用率较低,但滥用风险高于 BZDR。同时使用多种 PMed 的情况很常见。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Use and misuse of psychoactive medicines: a descriptive cross-sectional study in a densely populated region of Portugal.

Introduction: Although psychoactive medicines (PMed) are needed in several psychiatric conditions, their use and misuse bear risks. We aimed at estimating the prevalence of PMed use and misuse.

Methods: Data on all PMed prescribed in 2017 and dispensed in community pharmacies of the Lisbon and Tagus Valley region of Portugal (ARSLVT) were extracted from ARSLVT medicines' dispensing database. For 21 PMed among prescription opioids, benzodiazepines and z-drugs (BZDR), antidepressants (AD) and anticonvulsants (AC), we estimated the number of users of each PMed, and assessed PMed misuse by a set of proxy indicators for studying this practice: chronic use (use of ≥180 DDD during the study period) of PMed intended for short-term treatments, concomitant use of several PMed, in particular if involving long-term (≥ 30 days) opioid analgesic (OA) use, and doctor shopping (patients consulting several physicians in order to have access to a quantity higher than intended by each prescriber). Data were analysed using descriptive statistics and hypothesis testing, and multivariate logistic regression was used to explore potential factors affecting long-term concomitant treatment of chronic OA with other PMed.

Results: PMed use prevalence was 21.7%: 6.6% for OA, 12.7% for benzodiazepines (BZD), 5.3% for AD and 2.8% for AC. BZDR were mainly prescribed in primary care and OA in hospital outpatients. Chronic use of PMed was observed in 25%, especially with sertraline and buprenorphine for opioid use disorder (long-term treatment), and lorazepam (short-term treatment). About 56.6% of OA chronic users were long-term concurrent users with other PMed, mainly BZDR. Risk of abuse was low for BZDR, whilst four opioids had meaningful doctor shopping indicators - fentanyl, opioid use disorder buprenorphine, morphine and hydromorphone.

Conclusions: BZD are the main PMed used in ARSLVT, often chronically, especially lorazepam. Prevalence of OA use is low, although with higher risk of misuse than BZDR. Concomitant use of several PMed is frequent.

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来源期刊
Journal of Pharmaceutical Policy and Practice
Journal of Pharmaceutical Policy and Practice Health Professions-Pharmacy
CiteScore
4.70
自引率
9.50%
发文量
81
审稿时长
14 weeks
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