Benzodiazepine, z-drug and pregabalin prescriptions and mortality among patients in opioid maintenance treatment-A nation-wide register-based open cohort study
Benzodiazepine, z-drug and pregabalin prescriptions and mortality among patients in opioid maintenance treatment-A nation-wide register-based open cohort study
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DOI：
10.1016/j.drugalcdep.2017.01.013
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发表时间：
2017-05-01
影响因子：
4.2
通讯作者：
Hakansson, Anders
中科院分区：
文献类型：
--
作者：
Abrahamsson, Tove;Berge, Jonas;Hakansson, Anders
背景：使用镇静剂可能会增加阿片类药物使用者的死亡风险。本研究的目的是评估镇静剂处方是否可能与阿片类药物维持治疗患者的死亡率相关。 方法：这项基于登记的回顾性开放队列研究纳入了全国登记数据，其中包括 2005 年 7 月至 2012 年 12 月期间因阿片类药物依赖而接受美沙酮或丁丙诺啡作为阿片类药物维持治疗的所有个体 (N = 4501)。结果变量分别是药物过量死亡率和非药物过量死亡率。扩展 Cox 回归分析检查了镇静处方类型与死亡之间的关联，并控制了性别、年龄、既往用药过量和自杀企图、精神病住院治疗和阿片类药物维持治疗状态。假设在最后一次美沙酮或丁丙诺啡处方后，阿片类药物维持持续 90 天（或敏感性分析中为 30 天）。结果：苯二氮卓类处方与非用药过量死亡相关（HR：2.02，95% CI：1.29-3.18），但与用药过量死亡没有显着相关性（1.49，0.97-2.29）。 Z-药物 (1.60,1.07-2.39) 和普瑞巴林处方 (2.82, 1.79-4.43) 与过量死亡相关。在敏感性分析中，包括苯二氮卓类药物在内的所有类别的镇静剂均与过量死亡显着相关。结论：建议在阿片类药物维持治疗的患者开出镇静药物（包括苯二氮卓类药物、z-药物和普瑞巴林）时谨慎。 (C) 2017 年作者。由爱思唯尔爱尔兰有限公司出版
Background: Use of sedatives may increase risk of death in opioid users. The aim of the study was to assess whether prescription of sedatives may be associated with mortality in patients in opioid maintenance treatment.Methods: This retrospective register-based open cohort study included nation-wide register data including all individuals who were dispensed methadone or buprenorphine as opioid maintenance treatment for opioid dependence between July, 2005 and December, 2012 (N= 4501). Outcome variables were overdose mortality and non-overdose mortality, respectively. Extended Cox regression analyses examined associations between type of sedative prescriptions and death, controlling for sex, age, previous overdoses and suicide attempts, psychiatric in-patient treatment and opioid maintenance treatment status. Opioid maintenance was assumed to last for 90 days (or 30 days in a sensitivity analysis) after the last methadone or buprenorphine prescription.Results: Benzodiazepine prescriptions were associated with non-overdose death (HR: 2.02, 95% CI: 1.29-3.18) but not significantly associated with overdose death (1.49, 0.97-2.29). Z-drug (1.60,1.07-2.39) and pregabalin prescriptions (2.82, 1.79-4.43) were associated with overdose death. In the sensitivity analysis, all categories of sedatives, including benzodiazepines, were significantly associated with overdose death.Conclusions: Caution is advised when prescribing sedative drugs, including benzodiazepines, z-drugs and pregabalin, to patients in opioid maintenance treatment. (C) 2017 The Authors. Published by Elsevier Ireland Ltd.