Medication for Opioid Use Disorder After Nonfatal Opioid Overdose and Association With Mortality: A Cohort Study.
Medication for Opioid Use Disorder After Nonfatal Opioid Overdose and Association With Mortality: A Cohort Study.
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DOI：
10.7326/m17-3107
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发表时间：
2018-08-07
影响因子：
39.2
通讯作者：
Walley AY
中科院分区：
文献类型：
--
作者：
Larochelle MR;Bernson D;Land T;Stopka TJ;Wang N;Xuan Z;Bagley SM;Liebschutz JM;Walley AY
阿片类药物过量幸存者的死亡风险增加。阿片类药物使用障碍（mod）用药过量后是否与死亡率相关尚不清楚。确定阿片类药物过量后的mod使用及其与全因死亡率和阿片类药物相关死亡率的关系。回顾性队列研究。来自马萨诸塞州政府机构的7个独立关联的数据集。17568名未患癌症的马萨诸塞州成年人在2012年至2014年期间服用阿片类药物过量后幸存下来。研究了三种类型的mod：美沙酮维持治疗（MMT）、丁丙诺啡和纳曲酮。每隔一个月确定一次对mod的暴露，并认为在最后一次接收后的一个月内暴露。使用多变量Cox比例风险模型检验mod作为每月时变暴露变量来预测全因死亡率和阿片类药物相关死亡率的时间。在非致死性用药过量后的12个月内，2040人（11%）接受MMT治疗，中位时间为5个月（四分位数范围2至9个月），3022人（17%）接受丁丙诺啡治疗，中位时间为4个月（四分位数范围2至8个月），1099人（6%）接受纳曲酮治疗，中位时间为1个月（四分位数范围1至2个月）。在整个队列中，全因死亡率为每100人年4.7例死亡（95% CI， 4.4至5.0例死亡），阿片类药物相关死亡率为每100人年2.1例死亡（CI， 1.9至2.4例死亡）。与无mod相比，MMT与全因死亡率（校正危险比[AHR]， 0.47 [CI， 0.32至0.71]）和阿片类药物相关死亡率（AHR, 0.41 [CI， 0.24至0.70]）降低相关。丁丙诺啡与全因死亡率（AHR, 0.63 [CI， 0.46至0.87]）和阿片类药物相关死亡率（AHR, 0.62 [CI， 0.41至0.92]）降低相关。纳曲酮与全因死亡率（AHR, 1.44 [CI， 0.84至2.46]）或阿片类药物相关死亡率（AHR, 1.42 [CI， 0.73至2.79]）之间没有关联。在纳曲酮接受者中很少有事件妨碍了自信的结论。少数阿片类药物过量幸存者接受了mod治疗。丁丙诺啡和MMT与全因死亡率和阿片类药物相关死亡率降低相关。国立卫生研究院国家转化科学推进中心。
Opioid overdose survivors have an increased risk for death. Whether use of medications for opioid use disorder (MOUD) after overdose is associated with mortality is not known. To identify MOUD use after opioid overdose and its association with all-cause and opioid-related mortality. Retrospective cohort study. 7 individually linked data sets from Massachusetts government agencies. 17 568 Massachusetts adults without cancer who survived an opioid overdose between 2012 and 2014. Three types of MOUD were examined: methadone maintenance treatment (MMT), buprenorphine, and naltrexone. Exposure to MOUD was identified at monthly intervals, and persons were considered exposed through the month after last receipt. A multivariable Cox proportional hazards model was used to examine MOUD as a monthly time-varying exposure variable to predict time to all-cause and opioid-related mortality. In the 12 months after a nonfatal overdose, 2040 persons (11%) enrolled in MMT for a median of 5 months (interquartile range, 2 to 9 months), 3022 persons (17%) received buprenorphine for a median of 4 months (interquartile range, 2 to 8 months), and 1099 persons (6%) received naltrexone for a median of 1 month (interquartile range, 1 to 2 months). Among the entire cohort, all-cause mortality was 4.7 deaths (95% CI, 4.4 to 5.0 deaths) per 100 person-years and opioid-related mortality was 2.1 deaths (CI, 1.9 to 2.4 deaths) per 100 person-years. Compared with no MOUD, MMT was associated with decreased all-cause mortality (adjusted hazard ratio [AHR], 0.47 [CI, 0.32 to 0.71]) and opioid-related mortality (AHR, 0.41 [CI, 0.24 to 0.70]). Buprenorphine was associated with decreased all-cause mortality (AHR, 0.63 [CI, 0.46 to 0.87]) and opioid-related mortality (AHR, 0.62 [CI, 0.41 to 0.92]). No associations between naltrexone and all-cause mortality (AHR, 1.44 [CI, 0.84 to 2.46]) or opioid-related mortality (AHR, 1.42 [CI, 0.73 to 2.79]) were identified. Few events among naltrexone recipients preclude confident conclusions. A minority of opioid overdose survivors received MOUD. Buprenorphine and MMT were associated with reduced all-cause and opioid-related mortality. National Center for Advancing Translational Sciences of the National Institutes of Health.