Opioid overdose survivors: Medications for opioid use disorder and risk of repeat overdose in Medicaid patients.
Opioid overdose survivors: Medications for opioid use disorder and risk of repeat overdose in Medicaid patients.
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DOI：
10.1016/j.drugalcdep.2022.109269
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发表时间：
2022-03-01
影响因子：
4.2
通讯作者：
Treitler P
中科院分区：
文献类型：
--
作者：
Crystal S;Nowels M;Samples H;Olfson M;Williams AR;Treitler P
接受药物治疗的阿片类药物过量患者出现后续不良后果（包括重复过量）的风险很高。了解与重复用药过量相关的因素有助于优化用药过量后的干预措施。我们使用2014年至2019年的NJ Medicaid数据进行了纵向回顾性队列研究。从2015年到2018年，年龄在12-64岁之间的指数阿片类药物过量的医疗补助受益人被随访一年，以了解随后的过量。暴露量包括患者人口统计学资料;合并发生的医学、心理健康和物质使用障碍;索引药物过量前180天内的服务和药物使用;以及索引药物过量后的MOUD。在4898名符合入选标准的人中，19.6%在一年内重复使用阿片类药物过量。涉及海洛因/合成阿片类药物的指数过量与重复过量风险高于仅涉及处方/其他阿片类药物的指数过量相关（HR = 1.44，95% CI = 1.22-1.71）。男性和基线阿片类药物使用障碍诊断或艾德访视的风险较高。只有21.7%的人在用药过量后的一年中的任何时候接受了MOUD。MOUD与涉及海洛因/合成阿片类药物的索引过量患者中重复过量风险大幅降低相关（HR = 0.30，95% CI = 0.20-0.46）。在随访的任何时间点接受MOUD的患者中，10.5%（112/1065）的患者重复用药过量，而未接受MOUD的患者为22.1%（848/3833）。重复用药过量在接受药物治疗的阿片类药物过量患者中很常见。重复过量的风险因素因指数过量中涉及的阿片类药物类型而异，对干预的影响不同。涉及海洛因/合成阿片类药物的指数阿片类药物过量后的MOUD与重复过量风险降低相关。
Patients with medically-treated opioid overdose are at high risk for subsequent adverse outcomes, including repeat overdose. Understanding factors associated with repeat overdose can aid in optimizing post-overdose interventions. We conducted a longitudinal, retrospective cohort study using NJ Medicaid data from 2014 to 2019. Medicaid beneficiaries aged 12–64 with an index opioid overdose from 2015 to 2018 were followed for one year for subsequent overdose. Exposures included patient demographics; co-occurring medical, mental health, and substance use disorders; service and medication use in the 180 days preceding the index overdose; and MOUD following index overdose. Of 4898 individuals meeting inclusion criteria, 19.6% had repeat opioid overdoses within one year. Index overdoses involving heroin/synthetic opioids were associated with higher repeat overdose risk than those involving prescription/other opioids only (HR = 1.44, 95% CI = 1.22–1.71). Risk was higher for males and those with baseline opioid use disorder diagnosis or ED visits. Only 21.7% received MOUD at any point in the year following overdose. MOUD was associated with a large decrease in repeat overdose risk among those with index overdose involving heroin/synthetic opioids (HR = 0.30, 95% CI = 0.20–0.46). Among those receiving MOUD at any point in follow-up, 10.5% (112/1065) experienced repeat overdose versus 22.1% (848/3833) for those without MOUD. Repeat overdose was common among individuals with medically-treated opioid overdose. Risk factors for repeat overdose varied by type of opioid involved in index overdose, with differential implications for intervention. MOUD following index opioid overdose involving heroin/synthetic opioids was associated with reduced repeat overdose risk.
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影响因子：
6.2
作者：
Duber HC;Barata IA;Cioè-Peña E;Liang SY;Ketcham E;Macias-Konstantopoulos W;Ryan SA;Stavros M;Whiteside LK
通讯作者：
Whiteside LK
影响因子：
4.2
作者：
JOHNSON, RE;EISSENBERG, T;BIGELOW, GE
通讯作者：
BIGELOW, GE
影响因子：
5.3
作者：
Alpert, Abby;Powell, David;Pacula, Rosalie Liccardo
通讯作者：
Pacula, Rosalie Liccardo
影响因子：
120.7
作者：
Ling, Walter;Casadonte, Paul;Beebe, Katherine L.
通讯作者：
Beebe, Katherine L.
影响因子：
2.4
作者：
Carroll, Gerard G.;Wasserman, Deena D.;Haroz, Rachel
通讯作者：
Haroz, Rachel