我國醫師處方老年族群成癮性麻醉藥品行為之科學研究

Pain management in older adults has raised global concern in recent years, given the high prevalence of pain and growing use of addictive narcotics. Taiwan developed its aging society-structure since 1993, thus elderly pain epidemic threatens Taiwan’s public health. Physicians prescribe opioids to older adults more often in response to this globally exploding need. Parallelling to the enlarging amount of opioid prescriptions, misuse, abuse, non-medical use, along with increasing overdose deaths in the elderly were increasingly reported. This problematic opioid epidemic has suggested a negligible crisis to the safety of geriatrics. Aging-related changes in pharmacokinetics and pharmacodynamics result in higher risks of adverse events to the gastrointestinal, respiratory, central nervous and immune systems in the elders when exposed to opioid analgesics. Other than that, polypharmacy due to multiple concurrent diseases, timing of opioid initiation, appropriateness of initial doses, drug-drug interactions and multiple opioid prescriptions from different physicians all weaken the safety use of opioids in geriatrics. Long-term opioid use in the elders becomes a challenging dilemma for physicians to assess benefits and risks of opioid analgesics in older patients. Few international guidelines of opioid use in the elderly have been issued to response to the opioid crisis. However, such guidance in Taiwan is still in lack. The aims of current study are to investigate the prescribing patterns of addictive narcotics among Taiwanese elders, and to form a draft of clinical guidance for further policy application. Both qualitative and quantitative methods will be applied. The quantitative study will use cross-sectional cohort design to analyze opioid prescribing patterns by using the National Health Insurance Research Database. Physicians’ prescribing patterns, patient related risk factors and prescriber related factors will be analyzed. There are three parts in the qualitative study. Firstly, clinical evidence will be reviewed and compared to the findings from the analysis of Taiwan National Health Insurance Research Database to prepare a draft guidance. Secondly, the primary meeting of focus group, consisting of experts from medical practice, hospital management, academic associations and governmental agencies, will be held to examine and make the consensuses about the draft guideline. Finally, the draft guidance will be pretested in one medical center and one regional hospital. Second focus group meeting will be hold to discuss the issues and findings from the pretest to finalize the draft guideline. With evidence-based quantitative data analysis and thorough qualitative research, the current study will provide a nationwide clinical guidance to opioids use in the elderly for physicians in Taiwan. It is proposed that the results are able to provide valuable information in policy making and also promote quality care in the elderly.