A History of Being Prescribed Controlled Substances and Risk of Drug Overdose Death
A History of Being Prescribed Controlled Substances and Risk of Drug Overdose Death
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DOI：
10.1111/j.1526-4637.2011.01260.x
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发表时间：
2012-01-01
期刊：
影响因子：
3.1
通讯作者：
Loring, Larry D.
中科院分区：
文献类型：
--
作者：
Paulozzi, Leonard J.;Kilbourne, Edwin M.;Loring, Larry D.
目标。自1990年以来，滥用处方药的情况急剧增加。过量服用这类药物的人经常服用大剂量药物，并拜访多个提供者。阿片类镇痛药和镇静/催眠药不同使用模式的致死性过量风险尚未完全量化。配对病例对照研究。病例是2006年至2008年期间新墨西哥州300人死于非故意药物过量，对照组是5,993名通过州处方监测计划确定的患者，他们的暴露期为6个月。结果的措施。药物过量死亡或阿片类药物过量死亡。暴露是人口统计学变量和处方史特征。计算粗比值比和校正比值比（AOR）。风险增加与男性（AOR 2.4, 95%可信区间[CI] 1.8-3.1）、一种或多种镇静/催眠处方（AOR 3.0, CI 2.2-4.2）、年龄较大（AOR 1.3，每增加10年CI 1.2-1.4）、处方数量（AOR 1.1，每增加一种处方CI 1.1-1.1）、丁丙诺啡（AOR 9.5, CI 3.0-30.0）、芬太尼（AOR 3.5, CI 1.7-7.0）、氢吗啡酮（AOR 3.3, CI 1.4-7.5）、美沙酮（AOR 4.9, CI 2.5-9.6）或羟可酮(AOR 1.9，可信区间1.4 - -2.6)。每天平均接受40毫克吗啡当量的患者的OR为12.2 （CI 9.2-16.0）。频繁或高剂量服用阿片类镇痛药的患者面临严重的过量用药风险。处方监控程序可能是处方医生了解患者处方史和准确评估过量风险的最佳方式。
Objective. The abuse of prescription drugs has increased dramatically since 1990. Persons who overdose on such drugs frequently consume large doses and visit multiple providers. The risk of fatal overdose for different patterns of use of opioid analgesics and sedative/hypnotics has not been fully quantified.Design. Matched case-control study. Cases were 300 persons who died of unintentional drug overdoses in New Mexico during 2006-2008, and controls were 5,993 patients identified through the state prescription monitoring program with matching 6-month exposure periods. Outcome Measures. Death from drug overdose or death from opioid overdose. Exposures were demographic variables and characteristics of prescription history. Crude and adjusted odds ratios (AOR) were calculated.Results. Increased risk was associated with male sex (AOR 2.4, 95% confidence interval [CI] 1.8-3.1), one or more sedative/ hypnotic prescriptions (AOR 3.0, CI 2.2-4.2), greater age (AOR 1.3, CI 1.2-1.4 for each 10-year increment), number of prescriptions (AOR 1.1, CI 1.1-1.1 for each additional prescription), and a prescription for buprenorphine (AOR 9.5, CI 3.0-30.0), fentanyl (AOR 3.5, CI 1.7-7.0), hydromorphone (AOR 3.3, CI 1.4-7.5), methadone (AOR 4.9, CI 2.5-9.6), or oxycodone (AOR 1.9, CI 1.4-2.6). Patients receiving a daily average of >40 morphine milligram equivalents had an OR of 12.2 (CI 9.2-16.0).Conclusions. Patients being prescribed opioid analgesics frequently or at high dosage face a substantial overdose risk. Prescription monitoring programs might be the best way for prescribers to know their patients' prescription histories and accurately assess overdose risk.