臺灣地區十年來阿片類止痛藥使用趨勢之探討

The Trends of Requirements in Medical Opioid Analgesics from 1987 through 1996 in Taiwan

許俊卿(Chun-Ching Hsu) ； 李志恒(Jih-Heng Li)

《中華公共衛生雜誌》 17卷6期 (1998/12) Pp. 495-503

https://doi.org/10.6288/CJPH1998-17-06-07

摘要

調查臺灣地區1987年至1996年十年間阿片類止痛藥使用量成長情形，嗎啡口服劑成長17倍，注射劑成長9倍；可待因口服劑成長1.4倍，注射劑成長1.7倍；配西汀口服劑成長1.6倍，注射劑未見成長；吩坦尼注射劑成長2.7倍。嗎啡口服劑每年均為正成長，年成長率平均為38%，注射劑則除1989及1993兩年為負成長外，其餘為正成長，於1992年高達116%。可待因口服及注射劑年成長率為正負互見：配西汀口服及注射劑之年成長率都在±20%內，無大幅衰退或增加；吩坦尼注射劑年成長率則在5%~17%之間。嗎啡為WHO推薦之癌症疼痛治療主要用藥，臺灣地區使用量快速成長，但如以1991至1995年之每百萬人口每天嗎啡使用量為例，僅及英國的四十一分之一、美國的二十五分之一、日本的四分之一，顯示我國癌症疼痛治療仍有努力的空間。阻礙阿片類止痛藥使用的因素很多，仍需調查確切原因，同時應對醫事人員加強正確癌症疼痛醫療之教育，使癌症疼痛病人能獲得更妥善的醫療照顧。

關鍵字

嗎啡 ； 可待因 ； 配西汀 ； 麻醉藥品使用量

並列摘要

Selected narcotic drugs purchased by, manufactured by and managed by the National Narcotics Bureau between 1987 and 1996 in Taiwan were reviewed for the requirement trend. The requirement for morphine has increased 17 and 9 folds in oral (o) and injectable (i) preparations, respectively. The increases in other opioids were less substantial: 1.4 (o) and 1.7 (i) folds for codeine; 1.6 (o) folds and no (i) increase for pethidine; and 2.7 (i) folds for fentanyl. The use of oral morphine has constantly increased with an average annual growth ratio of 38% except that a slight lag was observed in 1989 and 1993. The use of morphine injections has steady increase with the highest growth of 116% in 1992. For oral and injectable forms of codeine and pethidine, the annual growth ratios have remained stagnant. The annual growths of fentanyl injections ranged between 5% and 17%. The growth of using morphine seemed very rapid, yet the average daily morphine consumption in Taiwan was still far behind that of many developed countries. Based on the ”defined daily doses” per million people, the daily morphine requirement compared with that of other nations was much lower in Taiwan: one to 41 compared with the U.K., one to 25 compared with the U.S., or one to four compared with Japan. In summary, the amount of narcotics supplements in the past in Taiwan suggests that patients might have received inadequate palliative care for cancer pain and other medical events. Further investigation on factors that might impede the use of opioid analgesics is expected. In addition, educational programs for medical professionals on proper pain controls are imperatively required.

並列關鍵字

morphine ； codeine ； pethidine ； narcotic consumption