Nonrandomized Intervention Study of Naloxone Coprescription for Primary Care Patients Receiving Long-Term Opioid Therapy for Pain
Nonrandomized Intervention Study of Naloxone Coprescription for Primary Care Patients Receiving Long-Term Opioid Therapy for Pain
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DOI：
10.7326/m15-2771
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发表时间：
2016-08-16
影响因子：
39.2
通讯作者：
Vittinghoff, Eric
中科院分区：
文献类型：
--
作者：
Coffin, Phillip O.;Behar, Emily;Vittinghoff, Eric
背景：非故意过量的阿片类镇痛剂是美国伤害相关死亡的主要原因。目的：评估对慢性疼痛患者使用纳洛酮处方的可行性和效果。设计：2年非随机干预研究。设置：加利福尼亚州旧金山的6家安全网初级保健诊所。参与者：1985名接受长期阿片类止痛药治疗的成年人。干预：对提供者和诊所工作人员进行纳洛酮处方的培训和支持。结果：患者处方纳洛酮的比例，阿片类药物相关急诊科(ED)就诊，结果：在1985例长期服用阿片类药物的患者中，38.2%的患者使用了纳洛酮。在过去12个月内有阿片类药物相关急症就诊的患者单独开出高剂量的阿片类药物的可能性更大。与未服用纳洛酮的患者相比，接受纳洛酮处方的患者在收到处方后的6个月内每月阿片类药物相关的ED就诊次数减少47%(发生率比0.53[95%CI，0.34~0.83]；P=0.005)，1年后就诊次数减少63%(IRR，0.37[CI，0.22~0.64]；P<；0.001)。在接受纳洛酮治疗和没有接受治疗的患者中，阿片类药物的剂量没有随时间的变化而发生净变化(IRR，1.03[CI，0.91到1.27]；P=0.61)。限制：结果是观察性的，不能在安全网设置之外推广。结论：纳洛酮可以被描述为初级保健患者服用阿片类止痛药。当被建议向所有接受阿片类药物的患者提供纳洛酮时，提供者可能会优先考虑那些具有既定风险因素的患者。在初级保健环境中提供纳洛酮可能有辅助益处，如减少阿片类药物相关的不良事件。
Background: Unintentional overdose involving opioid analgesics is a leading cause of injury-related death in the United States.Objective: To evaluate the feasibility and effect of implementing naloxone prescription to patients prescribed opioids for chronic pain.Design: 2-year nonrandomized intervention study.Setting: 6 safety-net primary care clinics in San Francisco, California.Participants: 1985 adults receiving long-term opioid therapy for pain.Intervention: Providers and clinic staff were trained and supported in naloxone prescribing.Measurements: Outcomes were proportion of patients prescribed naloxone, opioid-related emergency department (ED) visits, and prescribed opioid dose based on chart review.Results: 38.2% of 1985 patients receiving long-term opioids were prescribed naloxone. Patients prescribed higher doses of opioids and with an opioid-related ED visit in the past 12 months were independently more likely to be prescribed naloxone. Patients who received a naloxone prescription had 47% fewer opioid-related ED visits per month in the 6 months after receipt of the prescription (incidence rate ratio [IRR], 0.53 [95% CI, 0.34 to 0.83]; P = 0.005) and 63% fewer visits after 1 year (IRR, 0.37 [CI, 0.22 to 0.64]; P < 0.001) compared with patients who did not receive naloxone. There was no net change over time in opioid dose among those who received naloxone and those who did not (IRR, 1.03 [CI, 0.91 to 1.27]; P = 0.61).Limitation: Results are observational and may not be generalizable beyond safety-net settings.Conclusion: Naloxone can be coprescribed to primary care patients prescribed opioids for pain. When advised to offer naloxone to all patients receiving opioids, providers may prioritize those with established risk factors. Providing naloxone in primary care settings may have ancillary benefits, such as reducing opioid-related adverse events.