Association Between Buprenorphine for Opioid Use Disorder and Mortality Risk.
Association Between Buprenorphine for Opioid Use Disorder and Mortality Risk.
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DOI：
10.1016/j.amepre.2021.02.026
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发表时间：
2021-09
影响因子：
5.5
通讯作者：
Carnahan RM
中科院分区：
文献类型：
--
作者：
Vakkalanka P;Lund BC;Arndt S;Field W;Charlton M;Ward MM;Carnahan RM
与普通人群相比，患有阿片类药物使用障碍的退伍军人自杀和服用过量的风险更高。丁丙诺啡是美国食品和药物管理局批准的治疗阿片类药物使用障碍的药物，已显示出益处，包括降低非法药物使用和过量的风险。本研究评估了退伍军人在开始治疗后 5 年内丁丙诺啡药物治疗的死亡率结果。这是一项针对退伍军人健康管理局机构中接受丁丙诺啡（2008-2017 年）的退伍军人的回顾性队列研究。丁丙诺啡药物治疗作为时变协变量进行评估。主要结局是治疗开始后 5 年内因自杀和服药过量导致的死亡；次要结局包括自杀、用药过量、阿片类药物过量和全因死亡。二次分析包括评估最近停药的死亡风险以及通过选择特征进行的效果修改。所有分析均于 2020 年进行。未接受丁丙诺啡治疗的退伍军人因自杀/服药过量死亡的可能性是任何一天接受丁丙诺啡药物治疗的退伍军人的 4.33 倍（调整后风险比；95% CI=3.60, 5.21），与次要结局的治疗具有相似的保护性关联。与目前接受丁丙诺啡药物治疗的患者相比，停止治疗后 8-14 天的自杀/用药过量风险最高（调整后风险比 = 6.54，95% CI = 4.32，9.91）。没有证据表明所选协变量会改变效应。未接受丁丙诺啡药物治疗的退伍军人的死亡风险高于接受丁丙诺啡药物治疗的退伍军人。提供者应考虑丁丙诺啡药物治疗（无论是间歇性还是连续性）是否可以为其患者提供健康益处并预防死亡。
Veterans with opioid use disorder have an increased risk of suicide and overdose compared with the general population. Buprenorphine, a U.S. Food and Drug Administration–approved medication to treat opioid use disorder, has shown benefits, including decreased risk of illicit drug use and overdose. This study assesses the mortality outcomes with buprenorphine pharmacotherapy among Veterans up to 5 years from treatment initiation. This was a retrospective cohort study of Veterans receiving buprenorphine (2008–2017) across any Veterans Health Administration facility. Buprenorphine pharmacotherapy was evaluated as a time-varying covariate. The primary outcome was death up to 5 years from treatment initiation by suicide and overdose combined; secondary outcomes included suicide, overdose, opioid-specific overdose, and all-cause death. Secondary analyses included evaluating the risk of mortality in recent discontinuation and effect modification by select characteristics. All analyses were conducted in 2020. Veterans who were not receiving buprenorphine were 4.33 (adjusted hazard ratio; 95% CI=3.60, 5.21) times more likely to die by suicide/overdose than those receiving buprenorphine pharmacotherapy on any given day, with similar protective associations with treatment across secondary outcomes. The risk of suicide/overdose was highest 8–14 days from treatment discontinuation (adjusted hazard ratio=6.54, 95% CI=4.32, 9.91) than in currently receiving buprenorphine pharmacotherapy. There was no evidence of effect modification by the selected covariates. Mortality risk was greater among Veterans who were not receiving buprenorphine pharmacotherapy than among those who were. Providers should consider whether buprenorphine pharmacotherapy, either intermittent or continuous, may provide health benefits for their patients and prevent mortality.
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影响因子：
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作者：
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通讯作者：
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影响因子：
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作者：
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通讯作者：
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DOI：
10.1136/bmj.c5475
发表时间：
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期刊：
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影响因子：
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