Benzodiazepine prescribing patterns and deaths from drug overdose among US veterans receiving opioid analgesics: case-cohort study
Benzodiazepine prescribing patterns and deaths from drug overdose among US veterans receiving opioid analgesics: case-cohort study
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DOI：
10.1136/bmj.h2698
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发表时间：
2015-06-10
影响因子：
105.7
通讯作者：
Bohnert, Amy S. B.
中科院分区：
文献类型：
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作者：
Park, Tae Woo;Saitz, Richard;Bohnert, Amy S. B.
目的研究在接受阿片类镇痛剂治疗的美国退伍军人中，苯二氮卓类药物的处方模式(包括剂量、类型和给药程序)与药物过量死亡风险之间的关系。单位：退伍军人健康管理局(VHA)，2004-09。参与者是美国退伍军人，主要是男性，他们在2004-09年间接受了阿片类止痛药。所有在接受阿片类止痛药治疗期间死于药物过量(n=2400)的退伍军人和接受VHA医疗服务和阿片类止痛药的随机样本(n=420 386)退伍军人。主要结果测量药物过量死亡，定义为任何药物引起的故意、无意或不明死亡，由国家死亡指数中的死亡原因确定。结果在研究期间，接受阿片类止痛药的退伍军人中27%(n=112 069)的退伍军人也接受了苯二氮卓类药物治疗。大约一半的药物过量死亡(n=1185)发生在退伍军人同时服用苯二氮卓类药物和阿片类药物时。药物过量死亡的风险随苯二氮类药物处方史的增加而增加：调整后的危险比为2.33(95%可信区间为2.05~2.64)，以前处方与未处方相比为3.86(3.49~4.26)。药物过量死亡的风险随着每日苯二氮卓类药物剂量的增加而增加。与氯硝西潘相比，替马西潘可降低因药物过量而死亡的风险(0.63，0.48至0.82)。结论在接受阿片类镇痛剂治疗的退伍军人中，服用苯二氮卓类药物与过量用药死亡风险增加呈剂量-反应关系。
OBJECTIVETo study the association between benzodiazepine prescribing patterns including dose, type, and dosing schedule and the risk of death from drug overdose among US veterans receiving opioid analgesics.DESIGNCase-cohort study. Setting Veterans Health Administration (VHA), 2004-09. Participants US veterans, primarily male, who received opioid analgesics in 2004-09. All veterans who died from a drug overdose (n=2400) while receiving opioid analgesics and a random sample of veterans (n=420 386) who received VHA medical services and opioid analgesics.MAIN OUTCOME MEASUREDeath from drug overdose, defined as any intentional, unintentional, or indeterminate death from poisoning caused by any drug, determined by information on cause of death from the National Death Index.RESULTSDuring the study period 27% (n=112 069) of veterans who received opioid analgesics also received benzodiazepines. About half of the deaths from drug overdose (n=1185) occurred when veterans were concurrently prescribed benzodiazepines and opioids. Risk of death from drug overdose increased with history of benzodiazepine prescription: adjusted hazard ratios were 2.33 (95% confidence interval 2.05 to 2.64) for former prescriptions versus no prescription and 3.86 (3.49 to 4.26) for current prescriptions versus no prescription. Risk of death from drug overdose increased as daily benzodiazepine dose increased. Compared with clonazepam, temazepam was associated with a decreased risk of death from drug overdose (0.63, 0.48 to 0.82). Benzodiazepine dosing schedule was not associated with risk of death from drug overdose.CONCLUSIONSAmong veterans receiving opioid analgesics, receipt of benzodiazepines was associated with an increased risk of death from drug overdose in a dose-response fashion.