管控高成癮性止痛藥Pethidine之效益分析

Benefits Analysis of the Intervention for Highly Addictive Opioid Analgesic Pethidine

Pethidine屬第二級管制藥品主要用於短期止痛，因具高度成癮性且許多研究發現其止痛作用未優於其他類鴉片止痛劑，所以食藥署於100年與106年發布與更新Pethidine臨床使用指引期能降低其使用量，但臨床上仍習慣使用Pethidine。本醫院為南部某醫學中心於100年至106年使用量雖有逐步下降，但直至106年年用量仍高達8,091支。本研究欲探討本醫院於106年至111年期間藉由各項減量措施對於降低Pethidine使用量的效益分析。以人、事、時、地、物五面向思考Pethidine使用量高的原因，整理後歸納出五項對應措施予以執行：（一）進行宣導通知、（二）引進替代藥物、（三）減少公藥使用、（四）淘汰藥品與（五）資訊管控。本研究訂定Pethidine年使用量與Morphine/Pethidine耗用量比之兩項主要評估指標來衡量Pethidine減量的成效。統計106年至111年期間執行不同減量措施後每年Pethidine使用量資料，自106年年用量8,091支降至111年的192支，整體減量幅度為97.63%；統計106年至111年期間每年Morphine/Pethidine耗用量比，自106年耗用量比4.56:1增至111年的175.21:1，顯示若在Morphine使用量不變情形下，Pethidine使用量有大幅減少趨勢。本研究藉由不同減量措施對於降低Pethidine使用量成效顯著，減少Pethidine使用量除呼應國內外相關政策外，也能減少病人因長期使用Pethidine產生成癮性與中樞神經副作用，為病人用藥安全與品質把關。

Pethidine is classified as a Schedule II controlled substances in Taiwan primarily used for short-term pain relief. Due to its highly addictive and numerous studies suggesting that its analgesic effects are not superior to other opioid analgesics, the Taiwan Food and Drug Administration (TFDA) issued clinical guidelines in the years 2011 and 2017 to reduce its usage. However, Pethidine is still commonly used. In this study conducted at a medical center in southern Taiwan from 2011 to 2017, although the usage gradually decreased, the annual consumption remained high at 8,091 in 2017. The objective of this study is to analyze the benefits of various reduction measures implemented in the hospital from 2017 to 2022 in reducing Pethidine usage. Considering five aspects such as personnel, events, time, location, and resources, five corresponding measures were identified and implemented: (1) awareness campaigns, (2) the use of alternative medications, (3) reduction floor stock in ward supply, (4) discontinuation of Pethidine, and (5) information management. To assess the reduction in Pethidine usage, two primary indicators were established: annual Pethidine usage and the Morphine/Pethidine consumption ratio. Statistical analysis of the annual Pethidine consumption data from 2017 to 2022 revealed a decrease from 8,091 to 192, representing an overall reduction rate of 97.63%. Furthermore, the annual Morphine/Pethidine consumption ratio increased from 4.56:1 in 2017 to 175.21:1 in 2022, indicating a significant decrease in Pethidine usage trend while Morphine usage keeping constant. The study demonstrates that the various reduction measures significantly contributed to the decrease in Pethidine usage. Reducing Pethidine usage not only aligns with relevant domestic and international policies but also enhances patient safety and quality by minimizing the potential addiction and the side effect of central nervous system associated with long-term Pethidine use.