Association Between State Limits on Opioid Prescribing and the Incidence of Persistent Postoperative Opioid Use Among Surgical Patients.
Association Between State Limits on Opioid Prescribing and the Incidence of Persistent Postoperative Opioid Use Among Surgical Patients.
复制标题
国家对阿片类药物处方的限制与手术患者术后持续使用阿片类药物的发生率之间的关联。
DOI：
10.1097/sla.0000000000005283
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发表时间：
2023
影响因子：
9
通讯作者：
Jena,AnupamB
中科院分区：
文献类型：
--
作者：
Sun,EricC;Rishel,ChrisA;Waljee,JenniferF;Brummett,ChadM;Jena,AnupamB
目的：研究法律限制阿片类药物处方是否与术后持续使用阿片类药物的发生率降低有关。背景资料摘要：为了解决阿片类药物流行问题，26个州（截至2018年）通过了法律限制阿片类药物处方用于急性疼痛。然而，目前尚不清楚这些法律是否已经实现了他们的持续术后阿片类药物use.Methods的风险降低：我们确定了957,639私人保险的患者在2004年1月1日至2018年9月30日期间进行的10个程序之一。然后，我们估计了术后持续使用阿片类药物（定义为在术后91-365天内填写≥ 10份处方或≥ 120天的阿片类药物供应）与手术当天阿片类药物处方限制是否有效之间的相关性。国家分为：无限量、限量≤ 7天供应或限量> 7天供应。回归模型调整了可观察到的混杂因素，如患者合并症，并利用了差异中的差异方法，该方法依赖于州法律随时间的变化，以进一步减少混杂因素。术后持续使用阿片类药物的校正发生率为3.5%（95% CI 3.3%-3.7%），相比之下，3.3%的患者面临≤ 7天的供应限制（95% CI 3.3%-3.3%）无处方限制的患者（与无处方限制相比，差异P= 0.13）和3.4%，（95%CI 3.2%-3.6%）（与无处方限制相比差异P= 0.43）。结论：限制阿片类药物处方的法律与术后持续阿片类药物使用的后续减少无关。
Objective:To examine whether laws limiting opioid prescribing have been associated with reductions in the incidence of persistent postoperative opioid use.Summary of Background Data:In an effort to address the opioid epidemic, 26 states (as of 2018) have passed laws limiting opioid prescribing for acute pain. However, it is unknown whether these laws have achieved their reduced the risk of persistent postoperative opioid use.Methods:We identified 957,639 privately insured patients undergoing one of 10 procedures between January 1, 2004 and September 30, 2018. We then estimated the association between persistent postoperative opioid use, defined as having filled≥ 10 prescriptions or≥ 120 days supply of opioids during postoperative days 91–365, and whether opioid prescribing limits were in effect on the day of surgery. States were classified as having: no limits, a limit of≤ 7 days supply, or a limit of> 7 days supply. The regression models adjusted for observable confounders such as patient comorbidities and also utilized a difference-in-differences approach, which relied on variation in state laws over time, to further minimize confounding.Results:The adjusted incidence of persistent postoperative opioid use was 3.5%(95% CI 3.3%-3.7%) for patients facing a limit of≤ 7 days supply, compared with 3.3%(95% CI 3.3%-3.3%) for patients facing no prescribing limits (P= 0.13 for difference compared to no prescribing limits) and 3.4%,(95% CI 3.2%–3.6%) for patients facing a limit of> 7 days supply (P= 0.43 for difference compared to no prescribing limits).Conclusions:Laws limiting opioid prescriptions were not associated with subsequent reductions in persistent postoperative opioid use.