Changing Trends in Opioid Overdose Deaths and Prescription Opioid Receipt Among Veterans
Changing Trends in Opioid Overdose Deaths and Prescription Opioid Receipt Among Veterans
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DOI：
10.1016/j.amepre.2019.01.016
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发表时间：
2019-07-01
影响因子：
5.5
通讯作者：
Bohnert, Amy S. B.
中科院分区：
文献类型：
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作者：
Lin, Lewei (Allison);Peltzman, Talya;Bohnert, Amy S. B.
简介：为了告知过量预防，本研究评估了阿片类药物类别中阿片类药物过量死亡率的近期趋势以及退伍军人健康管理局中因过量死亡的退伍军人中处方阿片类镇痛药的接受情况。使用退伍军人健康管理局的记录与国家死亡指数数据，年度队列（2010-2016年）获得接受退伍军人健康管理局护理的退伍军人，并按阿片类药物过量类别进行检查（天然/半合成阿片类药物，海洛因，美沙酮和其他合成阿片类药物）（1）过量率和年龄，性别和种族/民族调整的比率变化;和（2）退伍军人健康管理局处方阿片类药物接收。结果：退伍军人阿片类药物过量的总体发生率从2010年的14.47/10万人年上升到2016年的21.08/10万人年（调整率比=1.65，95%CI =1.51，1.81）。美沙酮过量下降（校正率比=0.66，95% CI=0.51，0.84），天然/半合成阿片类药物过量无显著变化（校正率比=1.08，95% CI=0.94，1.24）。然而，合成阿片类药物过量率（校正率比=5.46，95% CI=4.41，6.75）和海洛因过量率（校正率比=4.91，95% CI=3.92，6.15）大幅增加。在所有阿片类药物过量死亡者中，死亡前3个月内接受处方阿片类药物的比例从2010年的54%下降到2016年的26%。阿片类药物的处方在死于各类阿片类药物过量的患者中有所下降;到2016年，只有少数人在过量后3个月内从退伍军人健康管理局接受阿片类镇痛药。未来的预防工作应该超越积极接受阿片类药物处方的患者。爱思唯尔公司出版《美国预防医学杂志》（American Journal of Preventive Medicine）
Introduction: To inform overdose prevention, this study assessed both recent trends in opioid overdose mortality across opioid categories and receipt of prescription opioid analgesics among Veterans who died from overdose in the Veterans Health Administration.Methods: Using Veterans Health Administration records linked to National Death Index data, annual cohorts (2010-2016) of Veterans who received Veterans Health Administration care were obtained and were examined by opioid overdose categories (natural/semisynthetic opioids, heroin, methadone, and other synthetic opioids) on (1) overdose rates and changes in rates adjusted for age, sex, and race/ethnicity; and (2) Veterans Health Administration prescription opioid receipt. Analyses were conducted in 2018.Results: The overall rate of opioid overdose among Veterans increased from 14.47 per 100,000 person-years in 2010 to 21.08 per 100,000 person-years in 2016 (adjusted rate ratio=1.65, 95% CI=1.51, 1.81). There was a decline in methadone overdose (adjusted rate ratio=0.66, 95% CI=0.51, 0.84) and no significant change in natural/semisynthetic opioid overdose (adjusted rate ratio=1.08, 95% CI=0.94, 1.24). However, the synthetic opioid overdose rate (adjusted rate ratio=5.46, 95% CI=4.41, 6.75) and heroin overdose rate (adjusted rate ratio=4.91, 95% CI=3.92, 6.15) increased substantially. Among all opioid overdose decedents, prescription opioid receipt within 3 months before death declined from 54% in 2010 to 26% in 2016.Conclusions: Opioid overdose rates among Veterans Health Administration Veterans increased because of increases in heroin and synthetic opioid overdose rates. Prescriptions of opioids declined among patients who died from all categories of opioid overdose; by 2016, only a minority received an opioid analgesic from Veterans Health Administration within 3 months of overdose. Future prevention efforts should extend beyond patients actively receiving opioid prescriptions. Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine.