Opioid tolerance and clinically recognized opioid poisoning among patients prescribed extended-release long-acting opioids.
Opioid tolerance and clinically recognized opioid poisoning among patients prescribed extended-release long-acting opioids.
复制标题
服用缓释长效阿片类药物的患者中的阿片类药物耐受性和临床上公认的阿片类药物中毒。
DOI：
10.1002/pds.4572
复制
发表时间：
2019
影响因子：
2.6
通讯作者：
JonssonFunk,Michele
中科院分区：
文献类型：
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作者：
Young,JessicaC;Lund,JenniferL;Dasgupta,Nabarun;JonssonFunk,Michele
背景认识到过量用药风险增加的可能性，延长释放和长效（ER/LA）阿片类药物的药物标签强调在开始高剂量之前需要建立阿片类药物耐受性。ObjectivesDescribe在开始90吗啡毫克当量（MME）ER/LA阿片类药物之前具有阿片类药物耐受性的患者比例，并检查随后的阿片类药物中毒风险。（2006 - 2015），以确定开始ER/LA阿片类药物治疗≥90 MME的患者。我们检查了处方史，并描述了阿片类药物耐受性（定义为前14天内≥7天的60 MME）的启动者比例。我们使用治疗加权考克斯比例风险模型的逆概率调整了年龄、性别、开始治疗的年份和基线合并症。我们估计调整后的风险比和95%置信区间阿片类药物耐受性的影响，对临床公认的阿片类药物中毒的风险（基于诊断代码）在特定时期（0 - 7，8 - 30，31 - 90，和91 - 365天）启动后initiation.ResultsAmong 372 038发起人，38%不符合阿片类药物耐受性标准。非耐受性引发者的比例最高，其中启动美沙酮（44%）和芬太尼（42%）。不耐受患者在ER/LA启动后一周内被诊断为阿片类药物中毒的可能性增加了37%（校正风险比= 1.37 [1.07，1.76]）。结论超过三分之一的启动≥90 MME ER/LA阿片类药物的患者没有阿片类药物耐受的证据。在既往无阿片类药物耐受的患者中，开始高剂量ER/LA治疗后7天可能是临床诊断的阿片类药物中毒的高风险期。
BackgroundIn recognition of potential for increased overdose risk, drug labels for extended‐release and long‐acting (ER/LA) opioids emphasize the need for established opioid tolerance prior to initiating high dosages.ObjectivesDescribe the proportion of patients with opioid tolerance prior to initiation of 90 morphine milligram equivalents (MME) ER/LA opioids and examine subsequent risk of opioid poisoning.MethodsWe used Truven Health Analytics' MarketScan Databases (2006‐2015) to identify patients initiating ER/LA opioids ≥90 MME. We examined prescription histories and describe the proportion of initiators with opioid tolerance (defined as ≥7 days of 60 MME in the prior 14 days). We adjusted for age, sex, year of initiation, and baseline comorbidities using inverse probability of treatment weighted Cox proportional hazards models. We estimated adjusted hazard ratios and 95% confidence intervals for the effect of opioid tolerance on the risk of clinically recognized opioid poisoning (based on diagnosis codes) in specific periods (0‐7, 8‐30, 31‐90, and 91‐365 days) following initiation.ResultsAmong 372 038 initiators, 38% did not meet opioid tolerance criteria. The proportion of nontolerant initiators was highest among those initiating methadone (44%) and fentanyl (42%). Nontolerant patients were 37% more likely to be diagnosed with opioid poisoning (adjusted hazard ratios = 1.37 [1.07, 1.76]) in the week following ER/LA initiation.ConclusionsOver one‐third of patients initiating ≥90 MME ER/LA opioids did not have evidence of opioid tolerance. The 7 days following high dose ER/LA initiation may represent a high‐risk period for clinically diagnosed opioid poisoning in patients who do not have prior opioid tolerance.