Prescription Opioid Dispensing Patterns Prior to Heroin Overdose in a State Medicaid Program: a Case-Control Study
Prescription Opioid Dispensing Patterns Prior to Heroin Overdose in a State Medicaid Program: a Case-Control Study
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DOI：
10.1007/s11606-020-06192-4
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发表时间：
2020-09-15
影响因子：
5.7
通讯作者：
Korthuis, P. Todd
中科院分区：
文献类型：
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作者：
Hartung, Daniel M.;Johnston, Kirbee A.;Korthuis, P. Todd
大部分使用海洛因的人报告开始使用阿片类药物处方阿片类药物。然而，尚未描述海洛因相关过量之前处方阿片类药物使用的模式。目的描述海洛因过量前一年处方阿片类药物的使用情况。设计病例对照研究，比较2015年至2017年处方阿片类药物使用与海洛因相关过量，非海洛因相关阿片类药物过量和非过量对照。参与者俄勒冈州医疗补助受益人与关联的行政索赔，重要统计数据和处方药监测计划数据。阿片类药物，苯二氮卓类药物和其他中枢神经系统药物过量前的处方;在有一种或多种阿片类药物处方的个体中，我们评估了每天吗啡毫克当量，重叠处方，多个处方者的处方，长期使用和停止长期使用。我们确定了1458例涉及海洛因的过量（191例致命）和2050例非海洛因涉及阿片类药物过量（266例致命）。在过量服用前的365天内，45%的海洛因过量服用者至少接受了一种处方阿片类药物，而78%的非海洛因过量服用者接受了阿片类药物（p < 0.001）。对于涉及海洛因和非海洛因的过量病例，接受阿片类药物的可能性随着年龄的增长而增加。在使用阿片类药物的海洛因过量病例中，多次药房使用率是唯一高于非过量对照的高风险阿片类药物模式（调整后的比值比为3.2; 95%置信区间为1.48至6.95）。在海洛因过量之前，长期阿片类药物使用的中止并不常见，并且不高于非过量对照组的中止率。结论：尽管与非海洛因阿片类药物过量病例相比，海洛因过量的个体在过量前一年接受处方阿片类药物的可能性较小，但处方阿片类药物的使用相对常见，并随着年龄的增长而增加。停止长期处方阿片类药物使用与海洛因过量无关。
Background A large proportion of individuals who use heroin report initiating opioid use with prescription opioids. However, patterns of prescription opioid use preceding heroin-related overdose have not been described. Objective To describe prescription opioid use in the year preceding heroin overdose. Design Case-control study comparing prescription opioid use with a heroin-involved overdose, non-heroin-involved opioid overdose, and non-overdose controls from 2015 to 2017. Participants Oregon Medicaid beneficiaries with linked administrative claims, vital statistics, and prescription drug monitoring program data. Main Measures Opioid, benzodiazepine, and other central nervous system depressant prescriptions preceding overdose; among individuals with one or more opioid prescription, we assessed morphine milligram equivalents per day, overlapping prescriptions, prescriptions from multiple prescribers, long-term use, and discontinuation of long-term use. Key Results We identified 1458 heroin-involved overdoses (191 fatal) and 2050 non-heroin-involved opioid overdoses (266 fatal). In the 365 days prior to their overdose, 45% of individuals with a heroin-involved overdose received at least one prescribed opioid compared with 78% of individuals who experienced a non-heroin-involved opioid overdose (p < 0.001). For both heroin- and non-heroin-involved overdose cases, the likelihood of receiving an opioid increased with age. Among heroin overdose cases with an opioid dispensed, the rate of multiple pharmacy use was the only high-risk opioid pattern that was greater than non-overdose controls (adjusted odds ratio 3.2; 95% confidence interval 1.48 to 6.95). Discontinuation of long-term opioid use was not common prior to heroin overdose and not higher than discontinuation rates among non-overdose controls. Conclusions Although individuals with a heroin-involved overdose were less likely to receive prescribed opioids in the year preceding their overdose relative to non-heroin opioid overdose cases, prescription opioid use was relatively common and increased with age. Discontinuation of long-term prescription opioid use was not associated with heroin-involved overdose.