Emergency Department Visits Among Recipients of Chronic Opioid Therapy
Emergency Department Visits Among Recipients of Chronic Opioid Therapy
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DOI：
10.1001/archinternmed.2010.273
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发表时间：
2010-09-13
影响因子：
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通讯作者：
Sullivan, Mark D.
中科院分区：
文献类型：
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作者：
Braden, Jennifer Brennan;Russo, Joan;Sullivan, Mark D.
背景：涉及处方阿片类药物使用的过量死亡和急诊就诊（edv）有所增加，但阿片类药物处方与不良后果之间的关系尚不清楚。方法：数据来自阿肯色州医疗补助计划和HealthCore商业保险参保人的行政索赔记录，这些参保人年龄在18岁及以上，在2000年至2005年的6个月内连续使用处方阿片类药物至少90天，并且没有癌症诊断。回归分析用于检查在处方阿片类药物90天或更长时间后12个月内发生edv和酒精或药物相关遭遇（ADEs）的危险因素。结果：头痛、背痛和既往存在的物质使用障碍与edv和ADEs显著相关。在HealthCore参与者中，精神健康障碍与edv和两个样本中的ADEs相关。每天阿片类药物剂量与edv并不一致相关，但吗啡当量剂量超过120 mg/d时，ade的风险增加了一倍。与单独使用非附表II阿片类药物相比，使用短效药物执法机构附表II阿片类药物与edv相关（相对风险范围为1.09-1.74）。附表II长效阿片类药物的使用与ade密切相关（相对风险范围，1.64-4.00）。结论：在处方阿片类药物90天或以上的成年人中，使用附表II阿片类药物、头痛、背痛和物质使用障碍与edv和ADEs相关。通过在这些高风险接受者中尽量减少附表II阿片类药物的处方，可能会增加慢性阿片类药物治疗的安全性。
Background: There has been an increase in overdose deaths and emergency department visits (EDVs) involving use of prescription opioids, but the association between opioid prescribing and adverse outcomes is unclear.Methods: Data were obtained from administrative claim records from Arkansas Medicaid and HealthCore commercially insured enrollees, 18 years and older, who used prescription opioids for at least 90 continuous days within a 6-month period between 2000 and 2005 and had no cancer diagnoses. Regression analysis was used to examine risk factors for EDVs and alcohol- or drug-related encounters (ADEs) in the 12 months following 90 days or more of prescribed opioids.Results: Headache, back pain, and preexisting substance use disorders were significantly associated with EDVs and ADEs. Mental health disorders were associated with EDVs in HealthCore enrollees and with ADEs in both samples. Opioid dose per day was not consistently associated with EDVs but doubled the risk of ADEs at morphine-equivalent doses over 120 mg/d. Use of short-acting Drug Enforcement Agency Schedule II opioids was associated with EDVs compared with use of non Schedule II opioids alone (relative risk range, 1.09-1.74). Use of Schedule II long-acting opioids was strongly associated with ADEs (relative risk range, 1.64-4.00).Conclusions: Use of Schedule II opioids, headache, back pain, and substance use disorders are associated with EDVs and ADEs among adults prescribed opioids for 90 days or more. It may be possible to increase the safety of chronic opioid therapy by minimizing the prescription of Schedule II opioids in these higher-risk recipients.