Association between concurrent use of prescription opioids and benzodiazepines and overdose: retrospective analysis.
Association between concurrent use of prescription opioids and benzodiazepines and overdose: retrospective analysis.
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DOI：
10.1136/bmj.j760
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发表时间：
2017-03-14
期刊：
影响因子：
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通讯作者：
Mackey S
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文献类型：
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作者：
Sun EC;Dixit A;Humphreys K;Darnall BD;Baker LC;Mackey S
目的确定苯二氮卓类药物和阿片类药物同时使用的趋势，并确定这些趋势对阿片类药物过量住院和急诊的影响。 设计索赔数据的回顾性分析，2001-13。 设置行政健康索赔数据库。 参与者315428名年龄在18-64岁之间的私人保险人，他们在研究期间连续参加了具有医疗和药房福利的健康计划，并且还填写了至少一个阿片类药物处方。 同时使用苯二氮卓类药物/阿片类药物，定义为每种药物处方所涵盖的时间段内至少有一天重叠。 主要结果测量阿片类药物使用者同时使用苯二氮卓类药物的年百分比;因阿片类药物过量而急诊和住院的年发生率。 2001年，9%的阿片类药物使用者还使用苯二氮卓类药物，2013年增加到17%（相对增加80%）。这一增加主要是由于间歇性类阿片使用者而非长期类阿片使用者的增加。与未使用苯二氮卓类药物的阿片类药物使用者相比，在所有阿片类药物使用者中，同时使用两种药物与因阿片类药物过量而急诊室就诊或住院的风险增加相关（校正比值比2.14，95%置信区间2.05至2.24; P<0.001）。对于间歇性阿片类药物使用者和慢性阿片类药物使用者，因阿片类药物过量而急诊室就诊或住院的调整后比值比分别为1.42（1.33至1.51; P<0.001）和1.81（1.67至1.96; P<0.001）。如果这种关联是因果关系，则消除苯二氮卓类药物/阿片类药物的同时使用可将与阿片类药物使用相关的急诊室就诊和阿片类药物过量住院的风险降低约15%（95%置信区间14 - 16）。 结论从2001年到2013年，在美国大样本的私人保险患者中，苯二氮卓类药物/阿片类药物的同时使用急剧增加，并显著增加了阿片类药物过量的总体人群风险。
Objectives To identify trends in concurrent use of a benzodiazepine and an opioid and to identify the impact of these trends on admissions to hospital and emergency room visits for opioid overdose. Design Retrospective analysis of claims data, 2001-13. Setting Administrative health claims database. Participants 315 428 privately insured people aged 18-64 who were continuously enrolled in a health plan with medical and pharmacy benefits during the study period and who also filled at least one prescription for an opioid. Interventions Concurrent benzodiazepine/opioid use, defined as an overlap of at least one day in the time periods covered by prescriptions for each drug. Main outcome measures Annual percentage of opioid users with concurrent benzodiazepine use; annual incidence of visits to emergency room and inpatient admissions for opioid overdose. Results 9% of opioid users also used a benzodiazepine in 2001, increasing to 17% in 2013 (80% relative increase). This increase was driven mainly by increases among intermittent, as opposed to chronic, opioid users. Compared with opioid users who did not use benzodiazepines, concurrent use of both drugs was associated with an increased risk of an emergency room visit or inpatient admission for opioid overdose (adjusted odds ratio 2.14, 95% confidence interval 2.05 to 2.24; P<0.001) among all opioid users. The adjusted odds ratio for an emergency room visit or inpatient admission for opioid overdose was 1.42 (1.33 to 1.51; P<0.001) for intermittent opioid users and 1.81 (1.67 to 1.96; P<0.001) chronic opioid users. If this association is causal, elimination of concurrent benzodiazepine/opioid use could reduce the risk of emergency room visits related to opioid use and inpatient admissions for opioid overdose by an estimated 15% (95% confidence interval 14 to 16). Conclusions From 2001 to 2013, concurrent benzodiazepine/opioid use sharply increased in a large sample of privately insured patients in the US and significantly contributed to the overall population risk of opioid overdose.