Concomitant opioid and benzodiazepine use and risk of suicide attempt and intentional self-harm: Pharmacoepidemiologic study.
Concomitant opioid and benzodiazepine use and risk of suicide attempt and intentional self-harm: Pharmacoepidemiologic study.
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DOI：
10.1016/j.drugalcdep.2021.109046
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发表时间：
2021-11-01
影响因子：
4.2
通讯作者：
Quinn PD
中科院分区：
文献类型：
--
作者：
Gibbons RD;Hur K;Quinn PD
由于同时使用阿片类药物和苯二氮卓类药物而过量已被提出作为一个主要的公共卫生问题，尽管很少有研究审查这种风险是否延伸到故意过量或其他自我伤害。这项研究调查了处方阿片类药物和苯二氮卓类药物是否会相互作用，增加自杀企图和故意自残的比率。该研究分析了来自MarketScan商业索赔和遭遇数据库（2014-2016）的4,762,438名阿片类药物、苯二氮卓类药物、两种药物同时使用或两种药物都不使用的使用者。使用治疗加权逆概率对四组进行匹配，并使用差异设计中的差异来检查自杀企图和故意自残风险的关联，包括导致医疗索赔的自杀死亡。阿片类药物与自杀企图和故意自残的相关性较小（HR=1.23; 95% CI 1.06 ~ 1.43），而苯二氮卓类药物与自杀企图和故意自残的相关性较大（HR=2.55; 95% CI 2.12 ~ 3.05）。药物相互作用与预期方向相反（HR=0.70; 95% CI 0.55 ~ 0.89），表明与同时使用相关的风险低于在相加基础上预期的风险。敏感性分析没有发现两类药物相互作用导致风险增加的证据。同时使用阿片类药物和苯二氮卓类药物会增加自杀企图和故意自残的风险，这在很大程度上可归因于单独使用苯二氮卓类药物。在通常规定的数量下，阿片类药物和苯二氮卓类药物可能不代表药物相互作用，因为它们会增加自杀企图和故意自残的风险，导致医疗护理。
Overdose due to concomitant use of opioids and benzodiazepines has been raised as a major public health concern, although little research has examined whether this risk extends to intentional overdose or other self-harm. This study examined whether prescription opioids and benzodiazepines interact to increase the rate of suicide attempt and intentional self-harm. The study analyzed 4,762,438 users of opioids, benzodiazepines, both drugs concomitantly, or neither drug from the MarketScan Commercial Claims and Encounters databases (2014–2016). The four groups were matched using inverse probability of treatment weighting and a difference in difference design was used to examine associations with risk of suicide attempt and intentional self-harm, including suicide death resulting in a medical claim. There was a small association for opioids (HR=1.23; 95% CI 1.06 to 1.43) but a larger association for benzodiazepines (HR=2.55; 95% CI 2.12 to 3.05) with suicide attempt and intentional self-harm. The medication interaction was opposite to the expected direction (HR=0.70; 95% CI 0.55 to 0.89), indicating that risk associated with concomitant use was lower than would be expected on an additive basis. Sensitivity analyses found no evidence of increased risk due to interaction between the two drug classes. Increased risk of suicide attempt and intentional self-harm for concomitant use of opioids and benzodiazepines is in large part attributable to benzodiazepine use alone. In typically prescribed quantities, opioids and benzodiazepines may not represent a drug interaction in terms of yielding increased risk of suicide attempt and intentional self-harm resulting in medical care.
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