Association Between Initial Opioid Prescribing Patterns and Subsequent Long-Term Use Among Opioid-Naive Patients: A Statewide Retrospective Cohort Study
Association Between Initial Opioid Prescribing Patterns and Subsequent Long-Term Use Among Opioid-Naive Patients: A Statewide Retrospective Cohort Study
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DOI：
10.1007/s11606-016-3810-3
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发表时间：
2017-01-01
影响因子：
5.7
通讯作者：
Millet, Lisa M.
中科院分区：
文献类型：
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作者：
Deyo, Richard A.;Hallvik, Sara E.;Millet, Lisa M.
阿片类药物对非癌症疼痛的长期疗效尚未得到证实，但风险主张谨慎处方。很少有数据表明阿片类药物初治患者可以开多长时间或多少阿片类药物而不会无意中促进长期使用。来自俄勒冈州居民处方的数据与死亡证明和出院有关。10月1日之间，2012年和2013年9月30日，在过去的365天内没有阿片类药物填充。亚组分析检查了45岁以下的患者，他们在随访的一年中没有死亡，排除了大多数癌症或姑息治疗患者。暴露：阿片类药物开始后30天（“开始月”）内处方填充和累积吗啡毫克当量（MME）的数量。结果：在随后的一年中有六次或六次以上阿片类药物填充的患者比例（“长期使用者”）。有536，767名阿片类药物初治患者填充阿片类药物处方。其中，26，785人（5.0%）成为长期使用者。初始月份的灌装次数和累积MME与长期使用相关。在45岁以下使用短效阿片类药物且在随访年内未死亡的患者中，接受两次填充与一次填充的长期使用的调整后比值比（OR）为2.25（95% CI：2.17，2.33）。与接受< 120个总MME的患者相比，接受400至799个MME的患者的OR为2.96（95%CI：2.81，3.11）。开始使用长效阿片类药物的患者比开始使用短效药物的患者有更高的长期使用风险。早期阿片类药物处方模式与长期使用相关。虽然患者特征很重要，但临床医生对初始处方有更大的控制权。我们的研究结果可能有助于最大限度地减少无意中开始长期使用阿片类药物的风险。
Long-term efficacy of opioids for non-cancer pain is unproven, but risks argue for cautious prescribing. Few data suggest how long or how much opioid can be prescribed for opioid-na < ve patients without inadvertently promoting long-term use.To examine the association between initial opioid prescribing patterns and likelihood of long-term use among opioid-na < ve patients.Retrospective cohort study; data from Oregon resident prescriptions linked to death certificates and hospital discharges.Patients filling opioid prescriptions between October 1, 2012, and September 30, 2013, with no opioid fills for the previous 365 days. Subgroup analyses examined patients under age 45 who did not die in the follow-up year, excluding most cancer or palliative care patients.Exposure: Numbers of prescription fills and cumulative morphine milligram equivalents (MMEs) dispensed during 30 days following opioid initiation ("initiation month"). Outcome: Proportion of patients with six or more opioid fills during the subsequent year ("long-term users").There were 536,767 opioid-na < ve patients who filled an opioid prescription. Of these, 26,785 (5.0 %) became long-term users. Numbers of fills and cumulative MMEs during the initiation month were associated with long-term use. Among patients under age 45 using short-acting opioids who did not die in the follow-up year, the adjusted odds ratio (OR) for long-term use among those receiving two fills versus one was 2.25 (95 % CI: 2.17, 2.33). Compared to those who received < 120 total MMEs, those who received between 400 and 799 had an OR of 2.96 (95 % CI: 2.81, 3.11). Patients initiating with long-acting opioids had a higher risk of long-term use than those initiating with short-acting drugs.Early opioid prescribing patterns are associated with long-term use. While patient characteristics are important, clinicians have greater control over initial prescribing. Our findings may help minimize the risk of inadvertently initiating long-term opioid use.