Relationship between concomitant benzodiazepine-opioid use and adverse outcomes among US veterans
Relationship between concomitant benzodiazepine-opioid use and adverse outcomes among US veterans
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DOI：
10.1097/j.pain.0000000000001111
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发表时间：
2018-03-01
期刊：
影响因子：
7.4
通讯作者：
Painter, Jacob T.
中科院分区：
文献类型：
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作者：
Gressler, Laura E.;Martin, Bradley C.;Painter, Jacob T.
患有精神健康障碍和疼痛的退伍军人通常使用苯二氮卓类药物和阿片类药物。本研究的目的是确定同时使用苯二氮卓类药物和阿片类药物是否会增加不良后果的发生率，使其高于仅使用非急性阿片类药物的基线风险。该数据集包含 2008 年至 2012 年期间至少开过 1 次阿片类药物处方的所有退伍军人。非急性阿片类药物使用的定义是在 60 天内阿片类药物处方超过或等于 20 天。联合使用被定义为阿片类药物和苯二氮卓类药物处方至少重叠 7 天。根据倾向评分，将仅使用阿片类药物的非急性使用者与同时使用阿片类药物和苯二氮卓类药物的使用者进行匹配。 365 天的观察期用于识别不良后果。主要结局检查是否存在以下一项或多项结局：与阿片类药物相关的事故和过量、与酒精和非阿片类药物相关的事故和过量、自伤、与暴力相关的伤害、总体伤口/伤害以及死亡。使用对伴随使用倾向进行控制的逻辑倾向评分调整回归来确定伴随使用与不良结果的关联。最终的匹配样本包括 396,141 名仅使用非急性阿片类药物的退伍军人和 48,971 名同时使用苯二氮卓类阿片类药物的使用者。同时接受阿片类药物和苯二氮卓类药物会增加出现不良结果的风险，比值比为 1.359（95% 置信区间：1.320-1.400；P < 0.0001）。在接受阿片类药物的退伍军人中，与仅使用阿片类药物的退伍军人的基线风险相比，同时使用苯二氮卓类药物与不良后果的风险增加相关。
Benzodiazepines and opioids are commonly used among veterans suffering from mental health disorders and pain conditions. The objective of this study is to determine whether concomitant benzodiazepine-opioid use increases the incidence of adverse outcomes above the baseline risk of nonacute opioid-only use. The dataset contained all veterans who filled at least 1 opioid prescription during the years 2008 to 2012. Nonacute opioid use was defined as having opioid prescriptions greater than or equal to 20 days within a 60-day period. Concomitant use was defined as having opioid and benzodiazepine prescriptions that overlapped for at least 7 days. Nonacute opioid-only users were matched to concomitant opioid-benzodiazepine users based on propensity scores. A 365-day observation period was used to identify adverse outcomes. The primary outcome examines the existence of one or more of the following outcomes: opioid-related accidents and overdoses, alcohol- and nonopioid drug-related accidents and overdoses, self-inflicted injuries, violence-related injuries, wounds/injuries overall, and death. A logistic propensity score adjusted regression controlling for propensity toward concomitant use was used to determine the association of concomitant use with adverse outcomes. The final matched sample consisted of 396,141 nonacute opioid-only using veterans and 48,971 concomitant benzodiazepine-opioid users. Receiving opioids and benzodiazepines concomitantly increased the risk of experiencing an adverse outcome with an odds ratio of 1.359 (95% confidence interval: 1.320-1.400; P < 0.0001). Among veterans receiving opioids, concomitant benzodiazepine use is associated with an increased risk of adverse outcomes when compared to the baseline risk of opioid-only using veterans.