Association of Household Opioid Availability and Prescription Opioid Initiation Among Household Members
Association of Household Opioid Availability and Prescription Opioid Initiation Among Household Members
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DOI：
10.1001/jamainternmed.2017.7280
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发表时间：
2018-01-01
影响因子：
39
通讯作者：
Brookhart, M. Alan
中科院分区：
文献类型：
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作者：
Seamans, Marissa J.;Carey, Timothy S.;Brookhart, M. Alan
美国处方阿片类药物使用的增加归因于处方指南的改变和对疼痛缓解的态度;然而，家庭内阿片类药物使用通过药物转移的传播也可能是一个促成因素。目的调查与处方阿片类药物使用者生活在一个家庭中的个人是否更有可能自己开始处方阿片类药物，设计、设置和参与者这是一项回顾性队列研究，使用了2000年至2014年的商业保险受益人的行政医疗保健索赔数据，这些受益人共享一个具有连续处方药覆盖的健康计划，在过去一年中没有使用阿片类药物或NSAID。从家庭成员首次开具合格阿片类药物或NSAID处方之日起，对入组者进行随访，直至1年后开始处方阿片类药物、退出或行政删失或2014年12月31日随访结束。阿片类药物启动的风险来自逆概率加权（IPW）Kaplan-Meier估计值，该估计值调整了潜在的混杂因素、预后因素和预测因素。暴露门诊药房处方阿片类药物或处方NSAID的配药。主要结局和指标门诊药房由家庭成员填写处方阿片类药物。结果从2000年到2014年，12 695 280人暴露于处方阿片类药物，6 359 639人通过家庭成员的索引处方暴露于处方NSAIDS。IPW估计第二年开始使用阿片类药物的风险为11.83%（95% CI，11.81%-11.85%），而在家庭中暴露于处方阿片类药物的个体中，（95% CI，11.09%-11.14%），导致风险差异为0.71%（95% CI，0.68%-0.74%）。与暴露适度相关的未测量混杂因素（例如，患病率差异= 0.9%）和结局（例如，风险差异= 0.9）调整所有测量变量后，可以解释我们观察到的总体风险差异估计值结论和相关性生活在一个有处方阿片类药物使用者的家庭中可能会增加处方阿片类药物使用的风险，这可能反映了获得这些产品的机会增加以及共同的风险因素，如处方者偏好和处方药监测。
IMPORTANCE Increases in prescription opioid use in the United States have been attributed to changing prescribing guidelines and attitudes toward pain relief; however, the spread of opioid use within households through drug diversion may also be a contributing factor.OBJECTIVE To investigate whether individuals living in a household with a prescription opioid user are more likely to initiate prescription opioids themselves, compared with individuals in households with a prescription nonsteroidal anti-inflammatory drug (NSAID) user.DESIGN, SETTING, AND PARTICIPANTS This was a retrospective cohort study using administrative health care claims data from 2000 to 2014 of commercial insurance beneficiaries sharing a health plan with continuous prescription drug coverage, without opioid or NSAID use in the prior year. Enrollees were followed from the date of the first prescription filled by a household member for an eligible opioid or NSAID until initiation of prescription opioids, disenrollment, or administrative censoring after 1 year or the end of follow-up on December 31, 2014. Risk of opioid initiation was derived from inverse probability-weighted (IPW) Kaplan-Meier estimators that adjusted for potential confounders, prognostic factors, and predictors of censoring.EXPOSURE Outpatient pharmacy dispensing of a prescription opioid or prescription NSAID.MAIN OUTCOMES AND MEASURES Incident outpatient pharmacy fill for a prescription opioid by a household member.RESULTS From 2000 to 2014, 12 695 280 individuals were exposed to prescription opioids and 6 359 639 to prescription NSAIDS through an index prescription to a household member. The IPW estimated risk of opioid initiation in the subsequent year was 11.83%(95% CI, 11.81%-11.85%) among individuals exposed to prescription opioids in the household, compared with 11.11% (95% CI, 11.09%-11.14%) among individuals exposed to prescription NSAIDs, resulting in a risk difference of 0.71%(95% CI, 0.68%-0.74%). An unmeasured confounder that is modestly associated with the exposure (eg, prevalence difference = 0.9%) and the outcome (eg, risk difference = 0.9) after adjustment for all measured variables could explain our observed estimate of the overall risk difference (0.71%).CONCLUSIONS AND RELEVANCE Living in a household with a prescription opioid user may increase risk of prescription opioid use, which may reflect both increased access to these products as well as shared risk factors, such as prescriber preference and prescription drug monitoring.