Associations of opioid prescription dose and discontinuation with risk of substance-related morbidity in long-term opioid therapy.
Associations of opioid prescription dose and discontinuation with risk of substance-related morbidity in long-term opioid therapy.
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DOI：
10.1097/j.pain.0000000000002415
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发表时间：
2022-04-01
期刊：
影响因子：
7.4
通讯作者：
D'Onofrio BM
中科院分区：
文献类型：
--
作者：
Quinn PD;Chang Z;Bair MJ;Rickert ME;Gibbons RD;Kroenke K;D'Onofrio BM
减少阿片类药物相关危害的努力减少了阿片类药物处方，但引起了人们对意外后果的担忧，特别是对长期接受阿片类药物治疗的人。需要进行研究，以解决关于物质相关发病率风险如何在Ltd OT及其停用期间发生变化的知识差距。这项研究使用了全国性的商业保险索赔数据和个人内的设计，以检查Ltd OT剂量和停药与物质相关发病率的关系。我们确定了2010-2018年间开始开阿片类药物处方并随后接受Ltd OT治疗的194 839名青少年和成年人。队列被跟踪的中位数为965天(四分位数范围为525-1550)，其中阿片类药物处方覆盖的中位数为176天(119-332)。在随访期间，发生了17582起与物质相关的急性发病事件，定义为要求急诊、住院和救护车运输，并被诊断为药物使用障碍或过量。与最初的治疗相比，在随后的>；60-120(调整后的优势比[OR]，1.29；95%CI，1.12-1.49)和>；120(OR，1.48；95%CI，1.24-1.76)的后续时期内，个体内的风险更大。停药后第1-30天的风险也比最初治疗期间更大(OR，1.19；95%CI，1.05-1.35)。然而，这并不比停产前30天内的风险大，这表明风险可能并不完全归因于停产本身。结果得到了阴性对照药物治疗分析和额外的敏感性分析的支持。他们表明，在最初的阿片类药物处方之后的治疗过程中，Ltd OT接受者可能会经历与物质相关的发病率风险增加，特别是在涉及更高剂量的时期。
Efforts to reduce opioid-related harms have decreased opioid prescription but have provoked concerns about unintended consequences, particularly for long-term opioid therapy (LtOT) recipients. Research is needed to address the knowledge gap regarding how risk of substance-related morbidity changes across LtOT and its discontinuation. The present study used nationwide commercial insurance claims data and a within-individual design to examine associations of LtOT dose and discontinuation with substance-related morbidity. We identified 194 839 adolescents and adults who initiated opioid prescription in 2010–2018 and subsequently received LtOT. The cohort was followed for a median of 965 days (interquartile range, 525–1550), of which a median of 176 days (119–332) were covered by opioid prescription. During follow-up, there were 17 582 acute substance-related morbidity events, defined as claims for emergency visits, inpatient hospitalizations, and ambulance transportation with substance use disorder or overdose diagnoses. Relative to initial treatment, risk was greater within individual during subsequent periods of >60–120 (adjusted odds ratio [OR], 1.29; 95% CI, 1.12–1.49) and >120 (OR, 1.48; 95% CI, 1.24–1.76) daily morphine milligram equivalents. Risk was also greater during days 1–30 after discontinuations than during initial treatment (OR, 1.19; 95% CI, 1.05–1.35). However, it was no greater than during the 30 days before discontinuations, indicating that the risk may not be wholly attributable to discontinuation itself. Results were supported by a negative control pharmacotherapy analysis and additional sensitivity analyses. They suggest that LtOT recipients may experience increased substance-related morbidity risk during treatment subsequent to initial opioid prescription, particularly in periods involving higher doses.
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影响因子：
4.2
作者：
Gordon KS;Manhapra A;Crystal S;Dziura J;Edelman EJ;Skanderson M;Kerns RD;Justice AC;Tate J;Becker WC
通讯作者：
Becker WC
影响因子：
3.7
作者：
Coffin, Phillip O.;Rowe, Christopher;Vittinghoff, Eric
通讯作者：
Vittinghoff, Eric
影响因子：
12.7
作者：
Cicero, Theodore J.;Ellis, Matthew S.;Kasper, Zachary A.
通讯作者：
Kasper, Zachary A.
影响因子：
39.2
作者：
Bohnert, Amy S. B.;Guy, Gery P., Jr.;Losby, Jan L.
通讯作者：
Losby, Jan L.
影响因子：
39.2
作者：
Dunn, Kate M.;Saunders, Kathleen W.;Von Korff, Michael
通讯作者：
Von Korff, Michael