The association between benzodiazepine prescription and aberrant drug-related behaviors in primary care patients receiving opioids for chronic pain.
The association between benzodiazepine prescription and aberrant drug-related behaviors in primary care patients receiving opioids for chronic pain.
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接受阿片类药物治疗慢性疼痛的初级保健患者中苯二氮卓类药物处方与异常药物相关行为之间的关联。
DOI：
10.1080/08897077.2016.1179242
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发表时间：
2016
期刊：
影响因子：
3.5
通讯作者：
Lasser,KarenE
中科院分区：
文献类型：
--
作者：
Park,TaeWoo;Saitz,Richard;Nelson,KerrieP;Xuan,Ziming;Liebschutz,JaneM;Lasser,KarenE
背景苯二氮卓类药物的使用与成瘾相关风险有关，但人们对其与接受阿片类药物治疗慢性疼痛的患者异常药物相关行为的关系知之甚少。作者检查了接受苯二氮卓类药物处方与 2 种异常药物相关行为、早期阿片类药物补充和使用阿片类药物治疗非癌症慢性疼痛的患者使用非法药物（可卡因）之间的关联。方法这是一项回顾性队列研究，纳入了 847 名患者，这些患者在 2011 年 9 月 1 日至 2012 年 8 月 31 日期间到医院初级保健诊所或两个社区卫生中心之一就诊次数≥1 次。所有患者在 6 个月内接受了 ≥3 次阿片类药物处方，且开具的阿片类药物处方至少间隔 21 天，并且在研究期间接受了 ≥1 次尿液药物筛查。 Cox 比例风险模型估计了第二次早期阿片类药物补充的风险，定义为在上一次相同药物处方后 7-25 天开出阿片类药物处方，作为随时间变化的苯二氮卓类药物处方的函数。逻辑回归模型检查了苯二氮卓类药物处方与可卡因尿液检测呈阳性之间的关系。根据人口统计数据和精神/物质使用障碍诊断对模型进行调整。结果 在研究期间，23% (n= 196) 的患者接受了 ≥1 种苯二氮卓类药物处方。 22% (n= 183) 的患者有 ≥2 次早期阿片类药物补充，11% (n= 93) 的患者有 ≥1 次可卡因尿液药物检测呈阳性。接受苯二氮卓类处方与第二次早期阿片类药物补充的风险增加相关，调整后的风险比 = 1.54（95% 置信区间 [CI]：1.09–2.18），但与可卡因测试阳性无关，调整后的比值比 = 1.07（95% CI：0.55–2.23）。 结论 在接受长期阿片类药物治疗的初级保健患者中，苯二氮卓类药物处方与早期阿片类药物补充有关，但与可卡因使用无关。进一步的研究应该更好地阐明向接受阿片类药物治疗慢性疼痛的患者开苯二氮卓类药物的风险和益处。
BackgroundBenzodiazepine use has been associated with addiction-related risks, but little is known about its association with aberrant drug-related behaviors in patients receiving opioids for chronic pain. The authors examined the association between receipt of a benzodiazepine prescription and 2 aberrant drug-related behaviors, early opioid refills and illicit drug (cocaine) use in patients receiving opioids for noncancer chronic pain.MethodsThis was a retrospective cohort study of 847 patients with ≥1 visit to either a hospital-based primary care clinic or one of two community health centers between September 1, 2011, and August 31, 2012. All patients received ≥3 opioid prescriptions written at least 21 days apart within 6 months, and ≥1 urine drug screen during the study period. A Cox proportional hazards model estimated the hazard of a second early opioid refill, defined as an opioid prescription written 7–25 days after the previous prescription for the same drug, as a function of time-varying benzodiazepine prescription. A logistic regression model examined the relationship between benzodiazepine prescription and a positive urine test for cocaine. Models were adjusted for demographics and mental/substance use disorder diagnoses.ResultsTwenty-three percent (n= 196) of patients received ≥1 benzodiazepine prescription during the study period. Twenty-two percent (n= 183) of patients had ≥2 early opioid refills, and 11% (n= 93) had ≥1 positive urine drug tests for cocaine. Receipt of benzodiazepine prescription was associated with an increased hazard of having a second early opioid refill, adjusted hazard ratio = 1.54 (95% confidence interval [CI]: 1.09–2.18), but not associated with a positive cocaine test, adjusted odds ratio = 1.07 (95% CI: 0.55–2.23).ConclusionsAmong primary care patients receiving chronic opioid therapy, benzodiazepine prescription was associated with early opioid refills but not with cocaine use. Further research should better elucidate the risks and benefits of prescribing benzodiazepines to patients receiving opioids for chronic pain.