Opioid-related overdose and chronic use following an initial prescription of hydrocodone versus oxycodone.
Opioid-related overdose and chronic use following an initial prescription of hydrocodone versus oxycodone.
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DOI：
10.1371/journal.pone.0266561
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发表时间：
2022
期刊：
影响因子：
3.7
通讯作者：
Fischer MA
中科院分区：
文献类型：
--
作者：
Weiner SG;Hendricks MA;El Ibrahimi S;Ritter GA;Hallvik SE;Hildebran C;Weiss RD;Boyer EW;Flores DP;Nelson LS;Kreiner PW;Fischer MA
氢可酮和羟考酮通常用于治疗疼痛。然而，初始处方后阿片类药物相关不良后果的风险差异尚不清楚。本研究旨在确定阿片类药物相关不良事件的风险，定义为长期使用或阿片类药物过量，首次处方氢可酮或羟考酮给阿片类药物初治患者。对俄勒冈州多个相关公共卫生数据集的回顾性分析。年龄在18岁及以上的成年患者，a）在2015-2017年期间接受了羟考酮或氢可酮的初始处方，B）在处方前一年没有阿片类药物处方或阿片类药物相关住院或急诊，随访至2018年底。第一年长期阿片类药物使用定义为≥6次阿片类药物处方（包括索引），处方之间的平均未覆盖天数≤30天。从保险索赔、出院数据或生命记录中指出了致死性或非致死性阿片类药物过量。在指数处方后，2.8%（n = 14，458）的个体发展为慢性使用，0.3%（n = 1，480）经历了过量。调整患者和索引处方特征后，接受羟考酮的患者发生慢性使用的几率低于接受氢可酮的患者（调整后的比值比= 0.95，95%置信区间（CI）0.91-1.00），但过量风险较高（调整后的风险比（aHR）= 1.65，95% CI 1.45-1.87）。与氢可酮联合对乙酰氨基酚相比，羟考酮单药治疗似乎大大增加了阿片类药物过量的风险（aHR 2.18，95% CI 1.86-2.57）。羟考酮联合对乙酰氨基酚也显示出显著增加（aHR 1.26，95% CI 1.06-1.50），但程度不同。在既往阿片类药物初治患者中，氢可酮长期使用的风险略高，而羟考酮与对乙酰氨基酚联合或单药治疗后过量的风险更高。为了减少过量相关的死亡，氢可酮可能是有利的药物。
Hydrocodone and oxycodone are prescribed commonly to treat pain. However, differences in risk of opioid-related adverse outcomes after an initial prescription are unknown. This study aims to determine the risk of opioid-related adverse events, defined as either chronic use or opioid overdose, following a first prescription of hydrocodone or oxycodone to opioid naïve patients. A retrospective analysis of multiple linked public health datasets in the state of Oregon. Adult patients ages 18 and older who a) received an initial prescription for oxycodone or hydrocodone between 2015–2017 and b) had no opioid prescriptions or opioid-related hospitalizations or emergency department visits in the year preceding the prescription were followed through the end of 2018. First-year chronic opioid use was defined as ≥6 opioid prescriptions (including index) and average ≤30 days uncovered between prescriptions. Fatal or non-fatal opioid overdose was indicated from insurance claims, hospital discharge data or vital records. After index prescription, 2.8% (n = 14,458) of individuals developed chronic use and 0.3% (n = 1,480) experienced overdose. After adjustment for patient and index prescription characteristics, patients receiving oxycodone had lower odds of developing chronic use relative to patients receiving hydrocodone (adjusted odds ratio = 0.95, 95% confidence interval (CI) 0.91–1.00) but a higher risk of overdose (adjusted hazard ratio (aHR) = 1.65, 95% CI 1.45–1.87). Oxycodone monotherapy appears to greatly increase the hazard of opioid overdose (aHR 2.18, 95% CI 1.86–2.57) compared with hydrocodone with acetaminophen. Oxycodone combined with acetaminophen also shows a significant increase (aHR 1.26, 95% CI 1.06–1.50), but not to the same extent. Among previously opioid-naïve patients, the risk of developing chronic use was slightly higher with hydrocodone, whereas the risk of overdose was higher after oxycodone, in combination with acetaminophen or monotherapy. With a goal of reducing overdose-related deaths, hydrocodone may be the favorable agent.
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影响因子：
13.8
作者：
Jenkin DE;Naylor JM;Descallar J;Harris IA
通讯作者：
Harris IA
CDC规定慢性疼痛的阿片类药物的指南 - 美国，2016年。
DOI：
10.1001/jama.2016.1464
发表时间：
2016-04-19
期刊：
JAMA
影响因子：
--
作者：
Dowell D;Haegerich TM;Chou R
通讯作者：
Chou R
影响因子：
5.7
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通讯作者：
Millet, Lisa M.
影响因子：
2
作者：
Austin, Peter C.
通讯作者：
Austin, Peter C.
影响因子：
6.2
作者：
Hoppe, Jason A.;Nelson, Lewis S.;Weiner, Scott G.
通讯作者：
Weiner, Scott G.