Illicit opioid use following changes in opioids prescribed for chronic non-cancer pain
Illicit opioid use following changes in opioids prescribed for chronic non-cancer pain
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DOI：
10.1371/journal.pone.0232538
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发表时间：
2020-05-04
期刊：
影响因子：
3.7
通讯作者：
Vittinghoff, Eric
中科院分区：
文献类型：
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作者：
Coffin, Phillip O.;Rowe, Christopher;Vittinghoff, Eric
背景经过几十年阿片类止痛药处方的增加，供应商正在迅速减少处方。我们假设，以前依赖阿片类止痛药的患者减少获得处方阿片类止痛药将导致增加非法阿片类药物use.Methods和findingsWe进行了一项回顾性队列研究，602公共保险的初级保健患者中谁已规定阿片类药物慢性非癌症疼痛至少连续三个月在旧金山弗朗西斯科，通过方便抽样招募。我们进行了一次历史重建访谈和医学图表提取，分别关注非法物质使用和阿片类止痛药处方，从2012年到2017-2018年的访谈日期。我们使用嵌套队列设计，根据阿片类止痛药剂量变化将患者分类为一系列嵌套队列，从每个随访季度开始。使用持续比率模型，我们分别估计了阿片类药物处方停药或剂量增加或减少30%（相对于无变化）与随后海洛因和非处方阿片类药物止痛药使用频率之间的相关性。控制人口统计学、临床和行为特征以及既往使用海洛因或非处方阿片类止痛药的模型。分别从597和598名参与者中纳入了56，372和56，484名参与者季度观察结果，用于分析海洛因和非处方阿片类止痛药的结果。与阿片类药物处方不变的参与者相比，停止处方阿片类药物的参与者更有可能在随后的季度中更频繁地使用海洛因（调整后比值比（AOR）= 1.57，95% CI：1.25-1.97）和非处方阿片类止痛药（AOR = 1.75，1.45-2.11）。阿片类止痛药剂量增加的参与者更有可能更频繁地使用海洛因（AOR = 1.67，1.32-2.12）。在整个敏感性分析中保持结果。主要的局限性是观察性质的结果和有限的概括性超出safety-net settings.ConclusionsDiscontinuation规定的阿片类止痛药与更频繁的非处方阿片类止痛药和海洛因的使用;增加剂量也与更频繁的海洛因使用。临床医生在确定疼痛管理方法时应该意识到这些风险。
BackgroundAfter decades of increased opioid pain reliever prescribing, providers are rapidly reducing prescribing. We hypothesized that reduced access to prescribed opioid pain relievers among patients previously reliant upon opioid pain relievers would result in increased illicit opioid use.Methods and findingsWe conducted a retrospective cohort study among 602 publicly insured primary care patients who had been prescribed opioids for chronic non-cancer pain for at least three consecutive months in San Francisco, recruited through convenience sampling. We conducted a historical reconstruction interview and medical chart abstraction focused on illicit substance use and opioid pain reliever prescriptions, respectively, from 2012 through the interview date in 2017-2018. We used a nested-cohort design, in which patients were classified, based on opioid pain reliever dose change, into a series of nested cohorts starting with each follow-up quarter. Using continuation-ratio models, we estimated associations between opioid prescription discontinuation or 30% increase or decrease in dose, relative to no change, and subsequent frequency of heroin and non-prescribed opioid pain reliever use, separately. Models controlled for demographics, clinical and behavioral characteristics, and past use of heroin or non-prescribed opioid pain relievers. A total of 56,372 and 56,484 participant-quarter observations were included from the 597 and 598 participants available for analyses of heroin and non-prescribed opioid pain reliever outcomes, respectively. Participants discontinued from prescribed opioids were more likely to use heroin (Adjusted Odds Ratio (AOR) = 1.57, 95% CI: 1.25-1.97) and non-prescribed opioid pain relievers (AOR = 1.75, 1.45-2.11) more frequently in subsequent quarters compared to participants with unchanged opioid prescriptions. Participants whose opioid pain reliever dose increased were more likely to use heroin more frequently (AOR = 1.67, 1.32-2.12). Results held throughout sensitivity analyses. The main limitations were the observational nature of results and limited generalizability beyond safety-net settings.ConclusionsDiscontinuation of prescribed opioid pain relievers was associated with more frequent non-prescribed opioid pain reliever and heroin use; increased dose was also associated with more frequent heroin use. Clinicians should be aware of these risks in determining pain management approaches.