Association of Opioid Prescriptions From Dental Clinicians for US Adolescents and Young Adults With Subsequent Opioid Use and Abuse
Association of Opioid Prescriptions From Dental Clinicians for US Adolescents and Young Adults With Subsequent Opioid Use and Abuse
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DOI：
10.1001/jamainternmed.2018.5419
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发表时间：
2019-02-01
影响因子：
39
通讯作者：
Park, K. T.
中科院分区：
文献类型：
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作者：
Schroeder, Alan R.;Dehghan, Melody;Park, K. T.
通过处方撰写，牙科临床医生是青少年最初阿片类药物暴露和随后滥用的潜在来源。目的研究2015年牙科临床医生针对阿片类药物初治青少年和年轻人的指数牙科阿片类药物处方与这一人群中新的持续使用和随后诊断的滥用之间的关系。设计、设置和参与者这项回溯性队列研究于2015年在Optom Research数据库中检查了16至25岁患者的门诊阿片类药物处方。处方通过国家提供者标识符号与临床医生类别相关联。EXPOSURES个人如果在2015年从牙科临床医生那里获得阿片类药物处方，在收到处方前连续12个月没有阿片类药物处方的记录，并在收到处方后有12个月的健康计划保险，则被包括在牙科阿片类药物(阿片类药物暴露)队列指数中。为每个阿片类药物接触者选择两名年龄和性别匹配的未接触阿片类药物的对照组，并分配相应的幻影处方日期。主要结果和衡量标准是在90-365天内收到阿片类药物处方，365天内被诊断为与阿片类药物滥用相关的医疗保健，以及365天内全因死亡率。结果在2015年继续登记的754 002人中，97 462名患者(12.9%)收到了1张或1张以上的阿片类药物处方，其中29 791例(30.6%)获得了牙科临床医生的处方。阿片类药物暴露队列包括14888名参与者(7882名女性[52.9%]，11273名白人[75.7%]，平均[SD]年龄21.8[2.4]岁)，而随机选择的非阿片类药物暴露队列包括29776名参与者(15764名女性[52.9%]，20078名白人[67.4%]，平均[SD]年龄21.8[2.4]岁)。在指数牙科阿片类药物队列中的14888人中，1021人(6.9%)在90到365天后接受了另一种阿片类药物处方，而29776人中有30人(0.1%)没有接触阿片类药物(调整后的绝对风险差，6.8%；95%的可信区间为6.3%-7.2%)，866名阿片类药物暴露者(5.8%)经历了1次或更多的后续医疗经历，与之相比，非阿片类药物暴露组的115人(0.4%)(调整后的绝对风险差异，5.3%；95%可信区间为5.0%~5.7%。每个队列中只有1人死亡。结论和相关性研究结果表明，相当大比例的青少年和年轻人通过牙科临床医生接触到阿片类药物。使用这些处方可能会增加随后使用和滥用阿片类药物的风险。
IMPORTANCE Through prescription writing, dental clinicians are a potential source of initial opioid exposure and subsequent abuse for adolescents and young adults.OBJECTIVE To examine the association between index dental opioid prescriptions from dental clinicians for opioid-naive adolescents and young adults in 2015 and new persistent use and subsequent diagnoses of abuse in this population.DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study examined outpatient opioid prescriptions for patients aged 16 to 25 years in the Optum Research Database in 2015. Prescriptions were linked by National Provider Identifier number to a clinician category.EXPOSURES Individuals were included in the index dental opioid (opioid-exposed) cohort if they filled an opioid prescription from a dental clinician in 2015, had continuous health plan coverage and no record of opioid prescriptions for 12 months before receiving the prescription, and had 12 months of health plan coverage after receiving the prescription. Two age- and sex-matched opioid-nonexposed control individuals were selected for each opioid-exposed individual and were assigned a corresponding phantom prescription date.MAIN OUTCOMES AND MEASURES Receipt of an opioid prescription within 90 to 365 days, a health care encounter diagnosis associated with opioid abuse within 365 days, and all-cause mortality within 365 days of the index opioid or phantom prescription date.RESULTS Among 754 002 individuals with continuous enrollment in 2015, 97 462 patients (12.9%) received 1 or more opioid prescriptions, of whom 29 791 (30.6%) received prescriptions supplied by a dental clinician. The opioid-exposed cohort included 14 888 participants (7882 women [52.9%], 11 273 white [75.7%], with mean [SD] age, 21.8 [2.4] years), and the randomly selected opioid-nonexposed cohort included 29 776 participants (15 764 women [52.9%], 20 078 [67.4%] white, with mean [SD] age, 21.8 [2.4] years). Among the 14 888 individuals in the index dental opioid cohort, 1021 (6.9%) received another opioid prescription 90 to 365 days later compared with 30 of 29 776 (0.1%) opioid-nonexposed controls (adjusted absolute risk difference, 6.8%; 95% CI, 6.3%-7.2%), and 866 opioid-exposed individuals (5.8%) experienced 1 or more subsequent health care encounters with an opioid abuse-related diagnosis compared with 115 opioid-nonexposed controls (0.4%) (adjusted absolute risk difference, 5.3%; 95% CI, 5.0%-5.7%). There was only 1 death in each cohort.CONCLUSIONS AND RELEVANCE The findings suggest that a substantial proportion of adolescents and young adults are exposed to opioids through dental clinicians. Use of these prescriptions may be associated with an increased risk of subsequent opioid use and abuse.