Factors Influencing Long-Term Opioid Use Among Opioid Naive Patients: An Examination of Initial Prescription Characteristics and Pain Etiologies.
Factors Influencing Long-Term Opioid Use Among Opioid Naive Patients: An Examination of Initial Prescription Characteristics and Pain Etiologies.
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DOI：
10.1016/j.jpain.2017.06.010
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发表时间：
2017-11
期刊：
影响因子：
--
通讯作者：
Martin BC
中科院分区：
文献类型：
--
作者：
Shah A;Hayes CJ;Martin BC
在这项回溯性队列研究中，使用来自具有全国代表性的美国商业保险患者数据库的医疗保险索赔数据，探索了初始阿片类药物处方的特征和疼痛病因与阿片类药物停用概率的关系。我们确定了1,353,902名年龄在≥14岁的没有癌症或药物滥用史的人，他们有新的阿片类药物使用经历，并将他们归类为11种相互排斥的疼痛病因。评估COX比例风险模型以确定与阿片类药物停用时间相关的因素。在考虑了随访的损失后，在所有受试者中，一年内继续使用阿片类药物的可能性为5.3%。慢性疼痛患者继续使用阿片类药物的可能性最高，其次是住院患者。患者处方剂量超过90毫克吗啡当量(HR=0.91，CI：0.91~0.92)；开始使用曲马多(HR=0.90，CI：0.89~0.91)或长效阿片类药物(HR=0.78，CI：0.75~0.80)；停用阿片类药物的可能性较小。增加第一个处方的供应天数与阿片类药物停用的可能性一致(HRs，顺：3-4天供应=0.70，0.70-0.71；5-7天供应=0.48，0.47-0.48；8-10天供应=0.37，0.37-0.38；11-14天供应=0.32，0.31-0.33；15-21天供应=0.29，0.28-0.29；≥供货天数=0.20，0.19-0.20)。这种关系的方向在所有疼痛原因中都是一致的。临床医生应该向阿片类药物供应最少的患者提供阿片类药物，以减少无意的长期阿片类药物使用。
The relationships of characteristics of the initial opioid prescription and pain etiology with the probability of opioid discontinuation were explored in this retrospective cohort study using health insurance claims data from a nationally representative database of commercially insured patients in the U.S. We identified 1,353,902 persons aged ≥14 with no history of cancer or substance abuse, with new opioid use episodes and categorized them into 11 mutually exclusive pain etiologies. Cox Proportional Hazards models were estimated to identify factors associated with time to opioid discontinuation. After accounting for losses to follow-up, the probability of continued opioid use at one year was 5.3% across all subjects. Patients with chronic pain had the highest probability for continued opioid use followed by patients with inpatient admissions. Patients prescribed doses above 90 morphine milligram equivalents (HR=0.91, CI: 0.91–0.92); initiated on tramadol (HR=0.90, CI: 0.89–0.91) or long-acting opioids (HR=0.78, CI: 0.75–0.80); were less likely to discontinue opioids. Increasing days’ supply of the first prescription was consistently associated with a lower likelihood of opioid discontinuation (HRs, CIs: 3–4 days’ supply = 0.70, 0.70–0.71; 5–7 days’ supply = 0.48, 0.47–0.48; 8–10 days’ supply = 0.37, 0.37–0.38; 11–14 days’ supply = 0.32, 0.31–0.33; 15–21 days’ supply = 0.29, 0.28– 0.29; ≥22 days supplied = 0.20, 0.19–0.20). The direction of this relationship was consistent across all pain etiologies. Clinicians should initiate patients with the lowest supply of opioids to mitigate unintentional long term opioid use.
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影响因子：
2.7
作者：
Cunningham JL;Craner JR;Evans MM;Hooten WM
通讯作者：
Hooten WM
影响因子：
4
作者：
Braden, Jennifer Brennan;Fan, Ming-Yu;Sullivan, Mark D.
通讯作者：
Sullivan, Mark D.
影响因子：
4.2
作者：
Babalonis, Shanna;Lofwall, Michelle R.;Walsh, Sharon L.
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Walsh, Sharon L.
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：
7.4
作者：
Hudson TJ;Painter JT;Martin BC;Austen MA;Williams JS;Fortney JC;Sullivan MD;Edlund MJ
通讯作者：
Edlund MJ