Patterns of Prescription Opioid Use Prior to Self-reported Heroin Initiation.
Patterns of Prescription Opioid Use Prior to Self-reported Heroin Initiation.
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自我报告开始使用海洛因之前处方阿片类药物的使用模式。
DOI：
10.1097/adm.0000000000000708
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发表时间：
2021-04-01
影响因子：
5.5
通讯作者：
Korthuis PT
中科院分区：
文献类型：
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作者：
Hartung DM;Geddes J;Johnston KA;Leichtling G;Hallvik S;Hildebran C;Korthuis PT
确定自我报告的海洛因吸食与处方阿片类药物使用模式之间的关联。使用关联的俄勒冈州医疗补助、处方药监测计划 (PDMP) 和治疗事件数据集数据，我们对 2015 年至 2017 年期间报告吸食海洛因的个人进行了病例对照研究。 PDMP 数据提供了自我报告的海洛因开始使用前一年的处方阿片类药物使用模式，包括长期处方阿片类药物治疗。四个对照与每个病例的处方阿片类药物使用总量和人口统计数据相匹配。大约一半（49%）的报告吸食海洛因的人在吸食海洛因前一年服用过阿片类药物。与匹配的对照组 (n=1,224) 相比，开始吸食海洛因的个体 (n=306) 更有可能从多个处方者 (24% vs 18%，p=0.007) 和药房 (12% vs 5%，p<0.001) 获得处方。长期阿片类药物治疗（13% vs 14%，p=0.74）并不常见，并且组间没有差异。尽管处方阿片类药物的使用通常先于自我报告的海洛因开始使用，但长期阿片类药物治疗并不常见。尽管这项研究没有发现阿片类药物停用与海洛因使用之间存在关联，但样本量和随访限制排除了明确的结论。限制处方阿片类药物的努力应继续评估意外伤害。
To determine the association between self-reported heroin initiation and patterns of prescription opioid use. Using linked Oregon Medicaid, prescription drug monitoring program (PDMP), and Treatment Episodes Data Set data, we conducted a case-control study of individuals reporting heroin initiation between 2015 and 2017 during treatment intake. PDMP data provided prescription opioid use patterns, including long-term prescription opioid therapy, in the year prior to self-reported heroin initiation. Four controls were matched to each case on aggregate prescription opioid use and demographics. About half (49%) of individuals who reported heroin initiation filled an opioid in the year prior to initiation. Individuals who initiated heroin (n=306) were more likely to receive prescriptions from multiple prescribers (24% vs 18%, p=0.007) and pharmacies (12% vs 5%, p<0.001) compared with matched controls (n=1,224). Long-term opioid therapy (13% vs 14%, p=0.74) was uncommon and did not differ between groups. Although prescription opioid use commonly preceded self-reported heroin initiation, long-term opioid therapy was not common. Although this study did not find an association between opioid discontinuation and heroin initiation, sample size and follow-up limitations preclude definitive conclusions. Efforts to limit prescription opioids should continue to evaluate for unintended harms.