Risk of Opioid Overdose Associated With Concomitant Use of Opioids and Skeletal Muscle Relaxants: A Population-Based Cohort Study
Risk of Opioid Overdose Associated With Concomitant Use of Opioids and Skeletal Muscle Relaxants: A Population-Based Cohort Study
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DOI：
10.1002/cpt.1807
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发表时间：
2020-07-01
影响因子：
6.7
通讯作者：
Winterstein, Almut G.
中科院分区：
文献类型：
--
作者：
Li, Yan;Delcher, Chris;Winterstein, Almut G.
最近的阿片类药物处方指南警告阿片类药物和骨骼肌松弛剂（SMR）的伴随处方，因为它们具有额外的中枢神经系统抑制作用。然而，临床相关性仍不清楚。在这项回顾性队列研究中，我们比较了阿片类药物和SMR合并使用与阿片类药物单独使用相关的阿片类药物过量风险。在事件和普遍阿片类药物使用者队列中，调整后的风险比分别为1.09（95%置信区间（CI），0.74-1.62）和1.26（95% CI，1.00-1.58），合并估计值为1.21（95% CI，1.00-1.48）。这种风险似乎随着治疗持续时间（60天：1.80和95% CI，1.30-2.48）以及巴氯芬（1.83和95% CI，1.11-3.04）和卡立普多（1.84和95% CI，1.34-2.54）而增加。每日阿片类药物剂量>= 50 mg（1.50和95% CI，1.18-1.92）和苯二氮卓类药物（1.39和95% CI，1.08-1.79）的合并使用者也有风险升高。临床医生应谨慎对待这些潜在的不安全做法，以优化疼痛护理并提高患者安全性。
The recent opioid prescribing guideline cautions about the concomitant prescribing of opioids and skeletal muscle relaxants (SMRs) given the additive central nervous system depressant effect. However, the clinical relevance remains unclear. In this retrospective cohort study, we compared the risk of opioid overdose associated with concomitant use of opioids and SMRs vs. opioid use alone. Adjusted hazard ratios were 1.09 (95% confidence interval (CI), 0.74-1.62) and 1.26 (95% CI, 1.00-1.58) in the incident and prevalent opioid user cohorts, respectively, generating a combined estimate of 1.21 (95% CI, 1.00-1.48). This risk seemed to increase with treatment duration (60 days: 1.80 and 95% CI, 1.30-2.48) and for baclofen (1.83 and 95% CI, 1.11-3.04) and carisoprodol (1.84 and 95% CI, 1.34-2.54). Concomitant users with daily opioid dose >= 50 mg (1.50 and 95% CI, 1.18-1.92) and benzodiazepine use (1.39 and 95% CI, 1.08-1.79) also had elevated risk. Clinicians should be cautious about these potentially unsafe practices to optimize pain care and improve patient safety.