Association between discontinuing chronic opioid therapy and newly diagnosed substance use disorders, accidents, self-inflicted injuries and drug overdoses within the prescribers' health care system: a retrospective cohort study.
Association between discontinuing chronic opioid therapy and newly diagnosed substance use disorders, accidents, self-inflicted injuries and drug overdoses within the prescribers' health care system: a retrospective cohort study.
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DOI：
10.1111/add.15689
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发表时间：
2022-04
期刊：
影响因子：
--
通讯作者：
Martin BC
中科院分区：
文献类型：
--
作者：
Hayes CJ;Krebs EE;Li C;Brown J;Hudson T;Martin BC
处方者通常面临停止阿片类药物治疗的患者处方慢性阿片类药物治疗（COT）。本研究旨在测量停止COT与物质使用障碍（SUDs）和阿片类药物相关不良结局（AOs）诊断之间的关系。回顾性队列研究美国退伍军人医疗管理局使用2009-2015财政年度的数据对停止阿片类药物治疗的COT慢性疼痛退伍军人进行了比较。评估了新诊断的物质使用障碍（SUD复合；个体类型：阿片类药物、非阿片类药物和酒精使用障碍）和阿片类药物相关不良后果（AO复合；个体类型：导致伤口/损伤的事故、阿片类药物相关事故/过量、酒精和非阿片类药物相关事故/过量、自我伤害和暴力相关伤害）。基于倾向评分和指标日期（±180天窗口），采用1:1匹配方法对未继续COT患者进行初步分析。敏感性分析采用稳定处理加权逆概率（SIPTW）和工具变量（IV）模型的逻辑回归进行。在检测SUD和AO发展的队列中，分别有15,695名（75.4%）和17,337名（76.6%）停药者与持续COT匹配。在主要倾向评分匹配分析中，停药组和继续COT组的综合SUD结局无差异(优势比（OR)=0.932, 95%可信区间（CI）： 0.850, 1.022）。与继续COT组相比，停止COT组的综合AO结果较低（OR=0.660, 95%CI: 0.623, 0.699）。SIPTW分析发现停药者的SUD （OR=0.789, 95%CI: 0.743, 0.837）和AO （OR=0.660, 95%CI: 0.623, 0.699）发生率较低。IV模型发现了混合的，有时甚至是相互矛盾的结果。停止慢性阿片类药物治疗的患者似乎与阿片类药物相关不良后果的诊断减少有关。与药物使用障碍的关联似乎尚无定论。
Prescribers are commonly confronted with discontinuing opioid therapy among patients prescribed chronic opioid therapy (COT). This study aimed to measure the association between discontinuing COT and diagnoses of substance use disorders (SUDs) and opioid-related adverse outcomes (AOs). Retrospective cohort study U.S. Veterans Healthcare Administration Veterans with chronic pain on COT who discontinued opioid therapy were compared with those continuing COT using data from fiscal years 2009–2015. Newly diagnosed substance use disorders (SUD composite; individual types: opioid, non-opioid drug, and alcohol use disorders) and opioid-related adverse outcomes (AO composite; individual types: accidents resulting in wounds/injuries, opioid-related accidents/overdoses, alcohol and non-opioid medication-related accidents/overdoses, self-inflicted injuries, and violence-related injuries) were evaluated. Primary analyses were conducted using 1:1 matching of discontinuers with those continuing COT based on propensity score and index date (±180-day window). Sensitivity analyses were conducted using logistic regressions with stabilized inverse probability of treatment weighting (SIPTW) and instrumental variable (IV) models. A total of 15,695 (75.4%) and 17,337 (76.6%) discontinuers were matched with those continuing COT among the cohorts testing SUD and AO development respectively. In the primary propensity score matched analyses, the composite SUD outcome was not different between discontinuers and those continuing COT (odds ratio (OR)=0.932, 95% confidence interval (CI): 0.850, 1.022). The composite AO outcome was lower among discontinuers (OR=0.660, 95%CI: 0.623, 0.699) compared with those continuing COT. SIPTW analyses found lower SUD (OR=0.789, 95%CI: 0.743, 0.837), and AO (OR=0.660, 95%CI: 0.623, 0.699) rates among discontinuers. IV models found mixed and sometimes contradictory results. Discontinuing patients from chronic opioid therapy appears to be associated with decreased diagnoses for opioid-related adverse outcomes. The association with substance use disorders appears to be inconclusive.
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DOI：
10.15585/mmwr.mm6610a1
发表时间：
2017-03-17
期刊：
MMWR. Morbidity and mortality weekly report
影响因子：
--
作者：
Shah A;Hayes CJ;Martin BC
通讯作者：
Martin BC
影响因子：
2.6
作者：
Austin, Peter C.
通讯作者：
Austin, Peter C.
影响因子：
5.7
作者：
James, Jocelyn R.;Scott, JoAnna M.;Merrill, Joseph O.
通讯作者：
Merrill, Joseph O.
影响因子：
6.1
作者：
SARGAN, JD
通讯作者：
SARGAN, JD
CDC规定慢性疼痛的阿片类药物的指南 - 美国，2016年。
DOI：
10.1001/jama.2016.1464
发表时间：
2016-04-19
期刊：
JAMA
影响因子：
--
作者：
Dowell D;Haegerich TM;Chou R
通讯作者：
Chou R