Opioid deaths involving concurrent benzodiazepine use: Assessing risk factors through the analysis of prescription drug monitoring data and postmortem toxicology.
Opioid deaths involving concurrent benzodiazepine use: Assessing risk factors through the analysis of prescription drug monitoring data and postmortem toxicology.
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DOI：
10.1016/j.drugalcdep.2021.108854
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发表时间：
2021-08-01
影响因子：
4.2
通讯作者：
Schmidt CJ
中科院分区：
文献类型：
--
作者：
Bannon MJ;Lapansie AR;Jaster AM;Saad MH;Lenders J;Schmidt CJ
阿片类药物死亡的比例很高，涉及同时使用苯二氮卓类药物。为了减少药物过量的风险，已经实施了各种处方药监测计划。本研究检查了同时使用苯二氮卓类药物对阿片类药物相关死亡的影响，以及密歇根州自动处方系统（MAPS）在预测阿片类药物死亡风险方面的效用。从2018年起，韦恩县医学检查办公室的病例在MAPS数据和MAPS衍生的药物风险评分以及死后毒理学方面进行了检查。将合并使用苯二氮卓类药物的阿片类药物死亡病例与非药物死亡病例进行比较。对于死亡前有6个月MAPS病史的病例，两组间阿片类药物处方的发生率无差异。相比之下，服用苯二氮卓类药物处方的阿片类药物死亡病例明显更多;阿普唑仑处方是阿片类药物死亡的单一最佳预测因子。各组在MAPS计算的药物风险评分上存在差异，尽管这些评分对阿片类药物死亡的预测性低于处方药使用的一些个体指标。在死后毒理学方面，芬太尼是队列之间最好的麻醉剂，与吗啡，苯二氮卓类药物或可卡因的使用有显著相关性。在死亡后一个月内填写处方的受试者子集中获得了类似的结果，除了MAPS风险评分不再预测药物死亡。MAPS评分不能充分预测阿片类药物相关死亡的风险。与预期相反，处方阿片类药物使用与阿片类药物相关死亡无关，而同时使用阿片类药物和苯二氮卓类药物是一个高度显著的风险因素。
A high proportion of opioid drug deaths involve concurrent benzodiazepine use. To reduce the risk of drug overdose, various prescription drug monitoring programs have been implemented. This study examined the impact of concurrent benzodiazepine use on opioid-related deaths, and the utility of the Michigan Automated Prescription System (MAPS) in predicting risk of opioid death. Wayne County Medical Examiner’s Office cases from 2018 were examined in terms of MAPS data and MAPS-derived drug risk scores, as well as postmortem toxicology. Opioid death cases with concurrent benzodiazepine use were compared to non-drug deaths. For cases with a MAPS history for 6 months preceding death, the incidence of opioid prescriptions filled did not differ between groups. In contrast, significantly more opioid death cases had filled a benzodiazepine prescription; alprazolam prescription was the single best predictor of opioid drug death. Groups differed in MAPS-calculated drug risk scores, though these were less predictive of opioid death than some individual measures of prescription drug use. In terms of postmortem toxicology, fentanyl was the best discriminator between cohorts, with significant associations seen for morphine, benzodiazepine, or cocaine use. Similar results were obtained in the subset of subjects filling a prescription within a month of death, except that MAPS risk scores no longer predicted drug deaths. MAPS scores did not adequately predict risk of opioid-related death. Contrary to expectations, prescription opioid use was not correlated with opioid-related death, whereas concurrent use of opioids and benzodiazepines represented a highly significant risk factor.
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DOI：
10.1198/106186006x137047
发表时间：
2006-09-01
影响因子：
2.4
作者：
Hansen, Ben B.;Klopfer, Stephanie Olsen
通讯作者：
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