Patterns of opioid prescriptions received prior to unintentional prescription opioid overdose death among Veterans
Patterns of opioid prescriptions received prior to unintentional prescription opioid overdose death among Veterans
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DOI：
10.1016/j.sapharm.2018.10.023
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发表时间：
2019-08-01
影响因子：
3.9
通讯作者：
Gellad, Walid F.
中科院分区：
文献类型：
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作者：
Moyo, Patience;Zhao, Xinhua;Gellad, Walid F.
背景：很少有研究评估非故意处方阿片类药物过量死亡前的处方阿片类药物供应，或描述这些个体的特征，特别是在退伍军人中。目的：描述退伍军人中处方阿片类药物过量死亡之前的处方阿片类药物供应历史。方法：在2008-2013年退伍军人健康管理局(VA)或联邦医疗保险D部分提供1张阿片类药物处方的全国队列中，我们确定了2012-2013年因无意或未确定意图的处方阿片类药物过量死亡。结果：在1181名死者中，643名(54.4%)在死亡当天有处方阿片类药物供应，735名(62.2%)在30天内有处方阿片类药物供应，而仅使用VA数据分别为40.1%和46.7%。有处方阿片类药物供应的死者年龄大得多，不太可能有酒精或非法药物作为过量服药的共生物质。使用关联数据，241例(20.4%)死者在死亡一年内缺乏处方阿片类药物供应。结论：许多死于处方阿片类药物过量的VA患者在VA之外接受阿片类药物处方或根本不接受。重要的是用非VA数据补充VA，以更准确地测量处方阿片类药物暴露，提高阿片类药物用药安全性。
Background: Few studies have assessed prescription opioid supply preceding death in individuals dying from unintentional prescription opioid overdoses, or described the characteristics of these individuals, particularly among Veterans.Objectives: To describe the history of prescription opioid supply preceding prescription opioid overdose death among Veterans.Methods: In a national cohort of Veterans who filled >= 1 opioid prescriptions from the Veterans Health Administration (VA) or Medicare Part D during 2008-2013, we identified deaths from unintentional or undetermined-intent prescription opioid overdoses in 2012-2013. We captured opioid prescriptions using both linked VA and Part D data, and VA data only.Results: Among 1181 decedents, 643 (54.4%) had prescription opioid supply on the day of death, and 735 (62.2%) within 30 days based on linked data, compared to 40.1% and 46.7%, respectively, using VA data alone. Decedents with prescription opioid supply were significantly older and less likely to have alcohol or illicit drugs as co-occurring substances involved in the overdose. Using linked data, 241 (20.4%) decedents lacked prescription opioid supply within a year of death.Conclusions: Many VA patients who die from prescription opioid overdose receive opioid prescriptions outside VA or not at all. It is important to supplement VA with non-VA data to more accurately measure prescription opioid exposure and improve opioid medication safety.