부산대학교 도서관

Byline: Yong-Fang Kuo, Mukaila A. Raji, Victor Liaw, Jacques Baillargeon, James S. Goodwin Objectives To examine how an October 2014 Drug Enforcement Administration policy reclassified hydrocodone product from schedule III to II has affected older adults, who are among the largest consumers of prescription opioids in the United States. Design Retrospective cohort study. Setting United States. Participants A 20% sample of Medicare Part D beneficiaries aged 65 and older from 2013 through 2015 (> 2,500,000 beneficiaries each year) Measurements From January 2013 to December 2015, we calculated the monthly prevalence of opioid prescriptions and the prevalence of individuals who received prescriptions for a 90-day supply or longer (prolonged), as well as hospitalizations related to opioid toxicity in 2013 and 2015. Results From 2013 to 2015, the proportion of Medicare Part D enrollees who received a hydrocodone prescription in a year decreased from 21.9% to 18.3%. Monthly rates for hydrocodone prescriptions declined significantly in 2014. The risk of receiving prolonged opioid prescriptions decreased by approximately 7% in the multivariable analyses comparing 2015 to 2013 (prevalence ratio=0.93, 95% confidence interval (CI)=0.93-0.94). Medicare enrollees with an original entitlement because of disability or with Medicaid eligibility had smaller decreases in prolonged prescriptions and, unexpectedly, small increases in high-dose prescriptions. Opioid-related hospitalizations did not change significantly, but opioid-related hospitalizations without a documented opioid prescription increased (odds ratio=1.24, 95% CI=1.03-1.50). Conclusion The 2014 change in hydrocodone from schedule III to schedule II was associated with modest decreases in rates of opioid use in the elderly. The unexpected increase in opioid-related hospitalizations without documented opioid prescriptions may represent an increase in illegal use. Supporting information: Additional Supporting Information may be found in the online version of this article Additional Supporting Information may be found in the online version of this article. CAPTION(S): Appendix S1. The steps for cohort construction. Appendix S2. Rates of opioid prescription by type of opioid in 2013 and 2015. Appendix S3. Characteristics of Medicare enrollees in 2013 and 2015. Appendix S4. Adjusted prevalence ratios for any, prolonged, and high-dose opioid prescription, 2013 versus 2015. Appendix S5. Absolute and relative changes in rates of any opioid prescriptions from 2013 to 2015, by participant characteristics. Appendix S6. Absolute and relative changes in rates of high-dose opioid prescriptions from 2013 to 2015, by participant characteristics. Appendix S7. Absolute and relative changes from 2013 to 2015 in prolonged opioid prescriptions, by state.