Trajectories of Opioid Use Following First Opioid Prescription in Opioid-Naive Youths and Young Adults.
Trajectories of Opioid Use Following First Opioid Prescription in Opioid-Naive Youths and Young Adults.
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DOI：
10.1001/jamanetworkopen.2021.4552
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发表时间：
2021-04-01
影响因子：
13.8
通讯作者：
Donohue J
中科院分区：
文献类型：
--
作者：
Wilson JD;Abebe KZ;Kraemer K;Liebschutz J;Merlin J;Miller E;Kelley D;Donohue J
在未使用过阿片类药物的青年（10-21岁）队列中首次使用阿片类药物处方后，存在哪些阿片类药物处方模式？在这项包括189477名青年的队列研究中，有两种不同的轨迹;高风险轨迹组中65.3%的患者在12个月时填充阿片类药物，而低风险轨迹组为13.1%。两种轨迹之间的差异持续超过12个月，高风险组中阿片类药物填充和阿片类药物使用障碍诊断的比例更大。在风险最高的轨迹中，即使是短剂量和低剂量的阿片类药物处方也与持续使用阿片类药物的风险增加有关。这项队列研究考察了首次使用阿片类药物的10至21岁青年的阿片类药物使用轨迹。虽然处方阿片类药物是青少年和年轻人开始使用阿片类药物的最常见方式，但许多研究检查了首次阿片类药物处方后的人群水平风险。目前缺乏对首次阿片类药物暴露后阿片类药物处方模式如何与长期风险相关的理解。使用基于组的轨迹建模确定首次处方后阿片类药物处方的不同模式，并检查第一年期间可能与轨迹成员资格相关的患者、临床医生和处方水平因素。这项队列研究检查了2010年至2016年宾夕法尼亚州医疗补助登记者的索赔数据。参与者在第一次阿片类药物处方时年龄为10至21岁。数据分析于二零二零年三月进行。本研究使用基于组的轨迹建模，并通过阿片类药物填充定义轨迹状态。在接受初始阿片类药物处方的189，477名青少年中，有107，562名女性（56.8%），81，915名非拉丁裔白色人（59.6%），中位年龄为16.9（四分位距[IQR]，14.6-18.8）岁。在随后的一年中，47477人（25.1%）接受了至少一次额外的处方。在所考虑的模型中，2组轨迹模型具有最佳拟合。在高风险轨迹中，65.3%（n = 901）在第12个月时填写阿片类药物处方，而低风险轨迹中为13.1%（n = 6031）。高风险轨迹中的中位年龄为19.0岁（IQR，17.1-20.0岁），而低风险轨迹中的中位年龄为17.8岁[IQR，15.8-19.4岁]。与低风险轨迹相比，高风险轨迹接受了更多有效的处方（高风险轨迹组的指数月中位剂量：10.0 MME/d [IQR，5.0-21.2 MME/d] vs低风险轨迹组：4.7 MME/d [IQR，2.5-7.8 MME/d]; P <0.001）。这些轨迹显示出持续的差异，与低风险组（10.1%; n = 4638）相比，高风险轨迹中更多的年轻人继续接受阿片类药物使用障碍的诊断（30.0%; n = 412）（P < .001）。这项研究的结果确定了与首次阿片类药物处方后12个月内持续接受阿片类药物风险升高相关的2个轨迹。高风险轨迹的特点是首次处方时年龄较大，首次处方时间较长且更有效。这些发现表明，即使是短剂量和低剂量的阿片类药物处方也可能与青少年持续使用的风险有关。
What patterns of opioid prescribing exist following the first opioid prescription in a cohort of opioid-naive youths (aged 10-21 years)? In this cohort study including 189 477 youths, there were 2 distinct trajectories; and 65.3% of patients in the high-risk trajectory group filled opioids at 12 months compared with 13.1% in the low-risk trajectory. Differences between the 2 trajectories persisted beyond 12 months, with a greater proportion of both opioid fills and opioid use disorder diagnoses in the high-risk group. Among the highest-risk trajectory, even short and low-dose opioid prescriptions were associated with increased risk of persistent opioid use. This cohort study examines trajectories of opioid use among youths aged 10 to 21 years who had been prescribed opioids for the first time. Although prescription opioids are the most common way adolescents and young adults initiate opioid use, many studies examine population-level risks following the first opioid prescription. There is currently a lack of understanding regarding how patterns of opioid prescribing following the first opioid exposure may be associated with long-term risks. To identify distinct patterns of opioid prescribing following the first prescription using group-based trajectory modeling and examine the patient-, clinician-, and prescription-level factors that may be associated with trajectory membership during the first year. This cohort study examined Pennsylvania Medicaid enrollees’ claims data from 2010 through 2016. Participants were aged 10 to 21 years at time of first opioid prescription. Data analysis was performed in March 2020. This study used group-based trajectory modeling and defined trajectory status by opioid fill. Among the 189 477 youths who received an initial opioid prescription, 107 562 were female (56.8%), 81 915 were non-Latinx White (59.6%), and the median age was 16.9 (interquartile range [IQR], 14.6-18.8) years. During the subsequent year, 47 477 (25.1%) received at least one additional prescription. Among the models considered, the 2-group trajectory model had the best fit. Of those in the high-risk trajectory, 65.3% (n = 901) filled opioid prescriptions at month 12, in contrast to 13.1% (n = 6031) in the low-risk trajectory. Median age among the high-risk trajectory was 19.0 years (IQR, 17.1-20.0 years) compared with the low-risk trajectory (17.8 years [IQR, 15.8-19.4 years]). The high-risk trajectory received more potent prescriptions compared with the low-risk trajectory (median dosage of the index month for high-risk trajectory group: 10.0 MME/d [IQR, 5.0-21.2 MME/d] vs the low-risk trajectory group: 4.7 MME/d [IQR, 2.5-7.8 MME/d]; P < .001). The trajectories showed persistent differences with more youths in the high-risk trajectory going on to receive a diagnosis of opioid use disorder (30.0%; n = 412) compared with the low-risk group (10.1%; n = 4638) (P < .001). This study’s results identified 2 trajectories associated with elevated risk for persistent opioid receipt within 12 months following first opioid prescription. The high-risk trajectory was characterized by older age at time of first prescription, and longer and more potent first prescriptions. These findings suggest even short and low-dose opioid prescriptions can be associated with risks of persistent use for youths.
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影响因子：
2
作者：
Squeglia LM;Jacobus J;Tapert SF
通讯作者：
Tapert SF
影响因子：
3.8
作者：
Henke, Rachel Mosher;Tehrani, Ali Bonakdar;Mark, Tami L.
通讯作者：
Mark, Tami L.
DOI：
10.1001/archpediatrics.2012.85
发表时间：
2012-09-01
影响因子：
--
作者：
McCabe, Sean Esteban;West, Brady T.;Boyd, Carol J.
通讯作者：
Boyd, Carol J.
影响因子：
39
作者：
Miller, Matthew;Barber, Catherine W.;Gagnon, David R.
通讯作者：
Gagnon, David R.
影响因子：
6
作者：
McCabe, Sean E.;West, Brady T.;Boyd, Carol J.
通讯作者：
Boyd, Carol J.