Association Between Benzodiazepine and Opioid Prescription and Mortality Among Patients in a Large Healthcare System.
Association Between Benzodiazepine and Opioid Prescription and Mortality Among Patients in a Large Healthcare System.
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DOI：
10.1097/adm.0000000000000828
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发表时间：
2022-01-01
影响因子：
5.5
通讯作者：
Hser YI
中科院分区：
文献类型：
--
作者：
Mooney LJ;Zhu Y;Yoo CK;Wolitzky-Taylor K;Hser YI
阿片类药物和苯二氮卓类药物(BDZ)的联合处方与不良后果有关，包括更大的医疗利用率和过量风险。这项研究旨在检查大型医疗系统中患有和不患有阿片类药物使用障碍(OUD)的患者的阿片类药物和BDZ联合处方、剂量和死亡率。这项研究使用了2010-2014年间加利福尼亚州处方药监测项目的数据，并与大型医疗保健系统电子健康记录数据库和疾病控制中心全国死亡指数的死亡记录相关联，调查了5202名患者(1,978名OUD患者，3,224名对照)。采用多元Logistic回归分析来检验最近的BDZ和阿片类药物处方之间的关系，以及它们与死亡率之间的相互作用。10.5%的样本在2014年12月31日或之前死亡。17.7%的患者在观察的最后一个月服用BDZ。有OUD的患者开出的BDZ和阿片类药物的平均剂量高于无OUD的患者。调整协变量后，增加处方剂量的BDZ(优势比[OR]=1.34，95%CI：1.15~1.55/10 mg/d)和阿片类药物(OR=1.04，95%CI：1.02~1.05/10 mg/d)与死亡率呈正相关。同时接受BDZ和阿片类药物处方的非OUD患者的死亡率高于仅接受BDZ或阿片类药物处方的患者(优势比(OR)=3.83，95%CI：1.78~8.21)。研究结果强调，在一般医疗保健环境中，与阿片类药物和BDZ的联合处方有关的显著死亡率。需要进一步的研究来阐明与联合使用阿片类药物和BDZ的非OUD患者的死亡率相关的因素。
Co-prescription of opioids and benzodiazepines (BDZ) is associated with adverse outcomes, including greater healthcare utilization and overdose risk. This study aims to examine opioid and BDZ co-prescription, dosing, and mortality among patients with and without opioid use disorder (OUD) in a large healthcare system. Using data from the California state Prescription Drug Monitoring Program during 2010–2014 linked with a large healthcare system electronic health record database and mortality records from the Centers for Disease Control National Death Index, this study examined 5,202 patients (1,978 with OUD, 3,224 controls). Multiple logistic regression analyses were conducted to examine relationships between most recent BDZ and opioid prescription, and their interaction with respect to mortality. 10.5% of the sample died on or before December 31, 2014. 17.7% were prescribed BDZ during the final month of observation. Individuals with OUD were prescribed higher average BDZ and opioid doses than those without OUD. After adjusting for covariates, increased prescribed doses of BDZ (odds ratio [OR]=1.34, 95%CI: 1.15–1.55 per 10 mg/day increment) and opioids (OR=1.04, 95%CI: 1.02–1.05 per 10 mg/day increment) were positively associated with mortality. Non-OUD patients who received both BDZ and opioid prescriptions had a higher mortality than those who received only BDZ or opioids (The ratio of odds ratio (ROR) =3.83, 95%CI: 1.78–8.21). Study findings highlight significant mortality associated with the co-prescription of opioids and BDZ in a general healthcare setting. Further research is needed to elucidate factors associated with mortality among non-OUD patients who are co-prescribed opioids and BDZ.