Incident and long-term opioid therapy among patients with psychiatric conditions and medications: a national study of commercial health care claims
Incident and long-term opioid therapy among patients with psychiatric conditions and medications: a national study of commercial health care claims
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DOI：
10.1097/j.pain.0000000000000730
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发表时间：
2017-01-01
期刊：
影响因子：
7.4
通讯作者：
D'Onofrio, Brian M.
中科院分区：
文献类型：
--
作者：
Quinn, Patrick D.;Hur, Kwan;D'Onofrio, Brian M.
越来越多的证据表明，美国的阿片类药物处方遵循一种模式，即阿片类药物不良后果风险最高的患者更有可能接受长期阿片类药物治疗。这些患者特别包括那些患有物质使用障碍（SUD）和其他精神疾病的患者。这项研究调查了10，311，961名服用阿片类药物处方的患者的健康保险索赔。具体来说，我们评估了阿片类药物的接受在有和没有广泛的预先存在的精神和行为状况的患者之间的差异（即阿片类和非阿片类SUD、自杀企图或其他自伤、机动车碰撞以及抑郁、焦虑和睡眠障碍）和精神活性药物（即抗抑郁药、苯二氮卓类、催眠药、情绪稳定剂、抗精神病药和用于SUD、戒烟和注意力缺陷/多动障碍的药物）。相对于那些没有，所有评估的精神疾病和药物的患者有适度的更大的可能性，随后填写阿片类药物的处方，特别是，长期阿片类药物接收的风险大大增加。在调整后的考克斯回归中，长期接受阿片类药物的风险增加范围为既往注意力缺陷/多动障碍药物处方的约1.5倍（风险比[HR] = 1.53; 95%置信区间[CI]，1.48-1.58）至既往非阿片类SUD诊断的约3倍（HR = 3.15; 95% CI，3.06-3.24），既往阿片类药物使用障碍诊断的风险增加近9倍（HR = 8.70; 95% CI，8.20-9.24）。总之，我们发现有证据表明，在患有各种精神疾病的商业保险患者中，阿片类药物的摄入量更大。未来评估与阿片类药物处方相关的行为结果的研究应考虑预先存在的精神疾病。
There is growing evidence that opioid prescribing in the United States follows a pattern in which patients who are at the highest risk of adverse outcomes from opioids are more likely to receive long-term opioid therapy. These patients include, in particular, those with substance use disorders (SUDs) and other psychiatric conditions. This study examined health insurance claims among 10,311,961 patients who filled prescriptions for opioids. Specifically, we evaluated how opioid receipt differed among patients with and without a wide range of preexisting psychiatric and behavioral conditions (ie, opioid and nonopioid SUDs, suicide attempts or other self-injury, motor vehicle crashes, and depressive, anxiety, and sleep disorders) and psychoactive medications (ie, antidepressants, benzodiazepines, hypnotics, mood stabilizers, antipsychotics, and medications used for SUD, tobacco cessation, and attention-deficit/hyperactivity disorder). Relative to those without, patients with all assessed psychiatric conditions and medications had modestly greater odds of subsequently filling prescriptions for opioids and, in particular, substantially greater risk of long-term opioid receipt. Increases in risk for long-term opioid receipt in adjusted Cox regressions ranged from approximately 1.5-fold for prior attention-deficit/hyperactivity disorder medication prescriptions (hazard ratio [HR] = 1.53; 95% confidence interval [CI], 1.48-1.58) to approximately 3-fold for prior nonopioid SUD diagnoses (HR = 3.15; 95% CI, 3.06-3.24) and nearly 9-fold for prior opioid use disorder diagnoses (HR = 8.70; 95% CI, 8.20-9.24). In sum, we found evidence of greater opioid receipt among commercially insured patients with a breadth of psychiatric conditions. Future studies assessing behavioral outcomes associated with opioid prescribing should consider preexisting psychiatric conditions.