Long-term Risk of Overdose or Mental Health Crisis After Opioid Dose Tapering.
Long-term Risk of Overdose or Mental Health Crisis After Opioid Dose Tapering.
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DOI：
10.1001/jamanetworkopen.2022.16726
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发表时间：
2022-06-01
影响因子：
13.8
通讯作者：
Tancredi, Daniel J.
中科院分区：
文献类型：
--
作者：
Fenton, Joshua J.;Magnan, Elizabeth;Tseregounis, Irakis Erik;Xing, Guibo;Agnoli, Alicia L.;Tancredi, Daniel J.
阿片类药物剂量递减是否与长期服用阿片类药物的患者过量、戒断或心理健康危机的长期风险降低相关？在这项队列研究中，19377例患者，在减量后阶段（开始减量后至少12个月，延长至24个月）与减量前阶段，调整后的发生率比值为1.57（停药过量）和1.52（心理健康危机）。两者都很重要。这些发现表明，阿片类药物剂量逐渐减少与药物过量戒断和心理健康危机的风险增加相关，这些风险在逐渐减少开始后持续长达2年。这项队列研究评估了与阿片类药物剂量逐渐减少相关的过量或心理健康危机的长期风险。接受长期阿片类药物治疗的患者越来越多地接受剂量递减。最近的研究表明，逐渐减少与药物滥用，过量和心理健康危机的短期风险有关，尽管较低的阿片类药物剂量可以降低长期不良事件的风险。评估与阿片类药物剂量递减相关的过量或心理健康危机的长期风险。这是一项使用交叉分析的队列研究。数据来自OptumLabs数据仓库，其中包括商业保险和Medicare Advantage注册者的去识别医疗和药房索赔以及注册记录，代表了美国各地年龄，种族，民族和地理区域的多样化混合。参与者是在2008年至2017年期间接受阿片类药物剂量逐渐减少的美国成年人，他们在12个月的基线期内稳定每日剂量为50毫克吗啡当量或更高，并且在逐渐减少开始后12个月开始的诱导后期间进行了至少1个月的长期随访。数据分析于二零二一年十月至二零二二年四月进行。阿片类药物减量，定义为稳定基线期后7个月随访期内6个重叠60天窗口期内的任何一个窗口期内平均日剂量相对减少15%或以上。因药物过量或戒断和心理健康危机（抑郁、焦虑或自杀企图）而急诊或住院。在减量前和诱导后阶段（减量开始后12至24个月）评估结局计数。该研究纳入了19377例患者中的21515起减量事件，每起事件的平均（SD）诱导后随访时间为9.1（2.7）个月（中位数[IQR]，10 [8-11]个月）。患者的平均（SD）年龄为56.9（11.2）岁，11581（53.8%）例为女性，8217（38.2%）例有商业保险（与Medicare Advantage相比）。在条件负二项回归分析中，诱导后阶段与减量前阶段相比，药物过量或停药的校正发生率比值为1.57（95% CI，1.42-1.74），心理健康危机为1.52（95% CI，1.35-1.71）。这些发现表明，阿片类药物逐渐减少与药物过量，戒断和心理健康危机的发生率增加相关，持续到逐渐减少开始后2年。
Is opioid dose tapering associated with reduced longer-term risks of overdose, withdrawal, or mental health crisis in patients prescribed long-term opioids? In this cohort study of 19 377 patients, in a posttaper period (beginning at least 12 months and extending up to 24 months after taper initiation) vs the pretaper period, the adjusted incidence rate ratios were 1.57 for overdose-withdrawal and 1.52 for a mental health crisis. Both were significant. These findings suggest that opioid dose tapering was associated increased risks of overdose-withdrawal and mental health crisis that persisted up to 2 years after taper initiation. This cohort study assesses the longer-term risks of overdose or mental health crisis associated with opioid dose tapering. Patients prescribed long-term opioid therapy are increasingly undergoing dose tapering. Recent studies suggest that tapering is associated with short-term risks of substance misuse, overdose, and mental health crisis, although lower opioid dose could reduce risks of adverse events over the longer term. To assess the longer-term risks of overdose or mental health crisis associated with opioid dose tapering. This is a cohort study using an exposure-crossover analysis. Data were obtained from the OptumLabs Data Warehouse, which includes deidentified medical and pharmacy claims and enrollment records for commercial insurance and Medicare Advantage enrollees, representing a diverse mixture of ages, races, ethnicities, and geographical regions across the US. Participants were US adults who underwent opioid dose tapering from 2008 to 2017 after a 12-month baseline period of stable daily dosing of 50 morphine milligram equivalents or higher and who had at least 1 month of long-term follow-up during a postinduction period beginning 12 months after taper initiation. Data analysis was performed from October 2021 to April 2022. Opioid tapering, defined as 15% or more relative reduction in mean daily dose during any of 6 overlapping 60-day windows within a 7-month follow-up period after the stable baseline period. Emergency or hospital encounters for drug overdose or withdrawal and mental health crisis (depression, anxiety, or suicide attempt). Outcome counts were assessed in pretaper and postinduction periods (from 12 to 24 months after taper initiation). The study included 21 515 tapering events among 19 377 patients with a mean (SD) of 9.1 (2.7) months of postinduction follow-up per event (median [IQR], 10 [8-11] months). Patients had a mean (SD) age of 56.9 (11.2) years, 11 581 (53.8%) were female, and 8217 (38.2%) had commercial insurance (vs Medicare Advantage). In conditional negative binomial regression analyses, adjusted incidence rate ratios for the postinduction period compared with the pretaper period were 1.57 (95% CI, 1.42-1.74) for overdose or withdrawal and 1.52 (95% CI, 1.35-1.71) for mental health crisis. These findings suggest that opioid tapering was associated with increased rates of overdose, withdrawal, and mental health crisis extending up to 2 years after taper initiation.
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影响因子：
13.8
作者：
Glanz, Jason M.;Binswanger, Ingrid A.;Xu, Stan
通讯作者：
Xu, Stan
影响因子：
39.2
作者：
Dunn, Kate M.;Saunders, Kathleen W.;Von Korff, Michael
通讯作者：
Von Korff, Michael
影响因子：
3
作者：
Moore, Brian J.;White, Susan;Elixhauser, Anne
通讯作者：
Elixhauser, Anne
影响因子：
13.8
作者：
Fenton, Joshua J.;Agnoli, Alicia L.;Magnan, Elizabeth
通讯作者：
Magnan, Elizabeth
CDC规定慢性疼痛的阿片类药物的指南 - 美国，2016年。
DOI：
10.1001/jama.2016.1464
发表时间：
2016-04-19
期刊：
JAMA
影响因子：
--
作者：
Dowell D;Haegerich TM;Chou R
通讯作者：
Chou R