Trends in opioid use disorder and overdose among opioid-naive individuals receiving an opioid prescription in Massachusetts from 2011 to 2014
Trends in opioid use disorder and overdose among opioid-naive individuals receiving an opioid prescription in Massachusetts from 2011 to 2014
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DOI：
10.1111/add.14867
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发表时间：
2019-12-21
期刊：
影响因子：
6
通讯作者：
Frakt, Austin B.
中科院分区：
文献类型：
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作者：
Burke, Laura G.;Zhou, Xiner;Frakt, Austin B.
目的：研究阿片类药物使用障碍（OUD）事件的风险，非致命性和致命性过量随着时间的推移在接受初始阿片类药物处方的阿片类药物初治个体中发生变化的情况。设计：回顾性纵向研究，使用马萨诸塞州第55章数据集，将多个管理数据集联系起来，研究阿片类药物的流行。我们确定了2011年至2014年马萨诸塞州阿片类初治阿片类药物治疗中OUD、非致死性和致死性药物过量的累积发生率，并估计了截至2015年的6个月和1、2、3和4年时这些结局的发生率。我们使用考克斯回归来检验初始处方的特征与这些结果的风险之间的关联。背景马萨诸塞州，美国。参与者为2011年至2015年年龄≥ 11岁的马萨诸塞州居民，未接受过阿片类药物治疗（在索引处方前6个月内无阿片类药物处方或OUD证据）（n = 2 154 426）。平均年龄为49.1岁，55.3%为女性，47.3%有商业保险。阿片类药物处方在处方监测计划（PMP）数据库中确定，初始处方数据库的特征也是如此。OUD和非致命性药物过量的结局是从所有付款人索赔数据库（APCD）中的索赔和急性医院病例组合文件中的医院遭遇中确定的。使用生命记录和统计登记处（RVRS）的死亡证明和首席医学检查官办公室（OCME）的死亡情况和毒理学报告确定了致命性过量。在接受初始阿片类药物处方的阿片类药物初治者中，OUD事件的风险在2011年至2014年期间似乎有所下降，而过量服用的比率基本不变。例如，1年OUD率在2011年为1.18%，2012年为1.11%，2013年为1.26%，2014年为0.94%。治疗持续时间越长，OUD [风险比（HR）= 2.24，持续时间≥ 3个月的95%置信区间（CI）= 2.19 - 2.29]、非致死性（HR = 1.67，95% CI = 1.53 - 1.82）和致死性阿片类药物过量（HR = 2.24，95% CI = 1.91 - 2.61）风险越高。同时接受苯二氮卓类药物治疗也与OUD（HR = 1.14，95% CI = 1.12 - 1.17）、非致死性（HR = 1.20，95% CI = 1.10 - 1.30）和致死性药物过量（HR = 1.86，95% CI = 1.61 - 2.16）风险升高相关。结论：在马萨诸塞州接受初始阿片类药物处方的阿片类药物初治者中，2011年至2014年期间，阿片类药物使用障碍的风险似乎有所下降，而过量用药率基本不变。较长的治疗持续时间和合并使用苯二氮卓类药物与阿片类药物使用障碍和阿片类药物过量的发生率较高相关。
Aims To examine how the risks of incident opioid use disorder (OUD), non-fatal and fatal overdose have changed over time among opioid-naive individuals receiving an initial opioid prescription. Design Retrospective, longitudinal study using the Massachusetts Chapter 55 data set, which linked multiple administrative data sets to study the opioid epidemic. We identified the cumulative incidence of OUD, non-fatal and fatal overdose among the opioid-naive initiating opioid treatment in Massachusetts from 2011 to 2014 and estimated rates of these outcomes at 6 months and at 1, 2, 3 and 4 years to 2015. We used Cox regression to examine the association between characteristics of the initial prescription and risk of these outcomes. Setting Massachusetts, USA. Participants Massachusetts residents aged >= 11 years in 2011-15 who were opioid-naive (no opioid prescriptions or evidence of OUD in the 6 months prior to the index prescription) (n = 2 154 426). The mean age was 49.1 years, 55.3% were female and 47.3% had commercial insurance. Measurements Opioid prescriptions were identified in the Prescription Monitoring Program (PMP) database, as were the characteristics of the initial prescription database. The outcomes of OUD and non-fatal overdose were identified from claims in the All Payer Claims Database (APCD) and hospital encounters in the acute hospital case mix files. Fatal overdoses were identified using Registry of Vital Records and Statistics (RVRS) death certificates and the Office of the Chief Medical Examiner (OCME) circumstances of death and toxicology reports. Findings Among opioid-naive individuals receiving an initial opioid prescription, the risk of incident OUD appears to have declined between 2011 and 2014, while rates of overdose were largely unchanged. For example, the 1-year OUD rate was 1.18% in 2011, 1.11% in 2012, 1.26% in 2013 and 0.94% in 2014. Longer therapy duration was associated with higher risk of OUD [hazard ratio (HR) = 2.24, 95% confidence interval (CI) = 2.19-2.29 for duration of 3 or more months], non-fatal (HR = 1.67, 95% CI = 1.53-1.82) and fatal opioid overdose (HR = 2.24, 95% CI = 1.91-2.61). Concurrent benzodiazepine treatment was also associated with higher risk of OUD (HR = 1.14, 95% CI = 1.12-1.17), non-fatal (HR = 1.20, 95% CI = 1.10-1.30) and fatal overdose (HR = 1.86, 95% CI = 1.61-2.16). Conclusions Among opioid-naive individuals in Massachusetts receiving an initial opioid prescription, the risk of incident opioid use disorder appears to have declined between 2011 and 2014, while rates of overdose were largely unchanged. Longer therapy duration and concurrent benzodiazepines were associated with higher rates of opioid use disorder and opioid overdose.