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<<   作成日時 : 2010/11/05 23:21   >>

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 新たな政府の報告によると、治療薬と違法薬物による副作用による入院患者数が1997-2008年で2倍になった。
 保健福祉省(HHS)の医療研究・品質調査機構(AHRQ)の報告によると、45歳以上の成人の、違法薬物や処方薬・市販薬による影響で入院となった患者の増加が目立つ。45-64才の薬剤関連の入院者数が、1997年と2008年の間で年間約30,000人から65,000人以上まで117%増加した。85歳以上の入院も87%増加した。こうした治療コストは2008年に11億ドルに達した。
 増加は3つのタイプ、薬剤性の譫妄、中毒、断薬、が関連している。鎮痛剤の中毒は、偶然の過量摂取や効果ないため大量摂取となる場合がある。薬物乱用は爆発的に増加している。過去10年で処方鎮静麻酔薬も著増している。

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Hospital Admissions for Drug Reactions Double
More Being Treated for Reactions to Drugs
http://abcnews.go.com/Health/Wellness/hospital-admissions-drug-reactions-double/story?id=12006849

By EMILY P. WALKER MedPage Today Washington Correspondent
Oct. 31, 2010

画像Hospital admissions for adverse reactions from medications and illegal drugs doubled in between 1997 and 2008, according to a new government report.

The report, released by the Department of Health and Human Services' (HHS) Agency for Healthcare Research and Quality (AHRQ) found that there was a major increase in hospital discharges from effects of both prescription and over-the-counter medications, as well as illegal drugs, among adults ages 45 and older.

"This report reveals a disturbing trend, and we need to find out more about why these admissions are increasing," said AHRQ director Dr. Carolyn M. Clancy in a press release.

Hospital admissions for drug-related conditions grew from about 30,000 per year to more than 65,000 per year -- a 117 percent increase -- between 1997 and 2008 for people ages 45 to 64, according to the report.

The increase was largely driven by hospitalizations from conditions related to three types of medications and drug-related conditions: drug-induced delirium; "poisoning" or overdose by codeine and other opiate-based pain medicines; and withdrawal from narcotic or non-narcotic drugs, according to the press release. "Poisoning" by pain medicines can be caused by accidental overdose or failing to recognize the drug's active ingredient and taking too many pills.

"Substance abuse is rising, and drug abuse of all kinds is exploding as a major public health concern for our country," said Pamela S. Hyde, administrator of HHS' Substance Abuse and Mental Health Services Administration. "The challenge for our healthcare practitioners is to see that patients receive medications when there is medical need but also to help prevent the adverse health consequences from drug use."

Given the explosion in the prescribing of narcotics over the past decade, the trend is not at all a surprise, Dr. John Dombrowski, an anesthesiologist at the Washington Pain Center, told MedPage Today.

Dombrowksi, who is a board member of the American Society of Anesthesiologists, explained that in the mid-1990s, there was a push for physicians to measure a new vital sign during office visits -- pain. Dombrowski said the increase in asking patients about their daily pain levels had both positive and negative effects.

On the one hand, many patients divulged malignant pain only after being asked to rate their daily pain on a scale. On the other hand, doctors asking patients about pain led to a huge increase in prescriptions for opioids, oftentimes to treat pain that could be managed better without drugs, according to Dombrowski.

"Unfortunately, Americans are a pill-taking society," Dombrowski said. " 'Sure -- give me a couple percocets and I'll feel better.' But that's not the right way to take care of nonmalignant pain. When you drown the patient in narcotics, they don't do too well."

The AHRQ report detected a similar trend among elderly people. Hospital admissions for drugs grew by 87 percent among people ages 85 and older.

However, among adults ages 18 to 44, hospitalization for medications and illegal drugs declined by 11 percent over the study period.

The cost of treating patients with medication and drug-related conditions was $1.1 billion in 2008. Medicare and Medicaid paid 57 percent of that cost, private insurance covered 24 percent, and 14 percent of the costs came from uninsured patients.

Dombrowski said he predicts the number of prescriptions for opioid painkillers will decrease as awareness of opioid abuse and misuse grows, and as the Department of Justice continues to focus on the issue.

The FDA recently proposed a plan to prevent inappropriate prescribing, misuse, and abuse of extended-release opioid painkillers. However, an FDA advisory committee voted 25-10 in July to reject the proposal, saying it lacked the teeth to stem the "public health crisis" of opioid addiction, overdose and death.

The agency's plan to put a risk evaluation and mitigation strategy (REMS) in place would have required drug companies that make extended-release opioids to develop educational programs to guide physicians in patient selection, dosing, and patient monitoring. Prescribers were also to have been trained to counsel their patients on how to safely store and dispose of opioids.


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