Predictors of Opioid-Related Death During Methadone Therapy
Predictors of Opioid-Related Death During Methadone Therapy
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DOI：
10.1016/j.jsat.2015.04.008
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发表时间：
2015-10-01
影响因子：
3.9
通讯作者：
Juurlink, David N.
中科院分区：
文献类型：
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作者：
Leece, Pamela;Cavacuiti, Christopher;Juurlink, David N.
我们的目的是检查目前接受美沙酮治疗阿片类药物使用障碍的患者中阿片类药物相关死亡率的药理学、人口统计学和医学共病风险因素。我们在加拿大安大略进行了一项以人群为基础的嵌套病例对照研究，该研究将1994年1月31日至2010年12月31日的医疗保健和验尸官记录联系起来。我们包括接受美沙酮治疗阿片类药物使用障碍的社会援助接受者。在这一组中，病例是死于类阿片相关原因的人。对于每种情况，我们在日历季度确定了最多5个匹配的对照。主要分析检查了精神药物（苯二氮卓类、抗抑郁药或抗精神病药）使用与阿片类药物相关死亡率之间的关联。次要分析检查了基线特征、卫生服务利用、合并症和阿片类药物相关死亡率之间的关系。在43，545例接受美沙酮治疗阿片类药物使用障碍的患者中，我们确定了175例（0.4%）阿片类药物相关死亡，沿着873例匹配对照。精神药物使用与阿片类药物相关死亡风险增加2倍相关（校正比值比（OR）2.0; 95%置信区间（CI）1.2至3.5）。具体而言，苯二氮卓类药物（校正OR 1.6; 95% CI 1.1 - 2.5）和抗精神病药（校正OR 23; 95% CI 1.5 - 3.5）与阿片类药物相关死亡独立相关。其他相关因素包括慢性肺病（校正OR 1.7; 95% CI 11.2 - 2.6）、酒精使用障碍（校正OR 1.9; 95% CI 1.2 - 32）、情绪障碍（校正OR 1.8; 95% CI 1.0 - 3.2）和心脏病史（校正OR 5.3; 95% CI 2.0 - 14.0）。精神药物使用与接受美沙酮治疗的患者中阿片类药物相关死亡相关。注意这些因素可能会降低美沙酮接受者的死亡风险。(C)2015年，作者。爱思唯尔公司出版
We aimed to examine pharmacologic, demographic and medical comorbidity risk factors for opioid-related mortality among patients currently receiving methadone for an opioid use disorder. We conducted a population-based, nested case-control study linking healthcare and coroner's records in Ontario, Canada, from January 31, 1994 to December 31, 2010. We included social assistance recipients receiving methadone for an opioid use disorder. Within this group, cases were those who died of opioid-related causes. For each case, we identified up to 5 controls matched on calendar quarter. The primary analysis examined the association between use of psychotropic drugs (benzodiazepines, antidepressants or antipsychotics) and opioid-related mortality. Secondary analyses examined the associations between baseline characteristics, health service utilization, comorbidities and opioid-related mortality. Among 43,545 patients receiving methadone for an opioid use disorder, we identified 175 (0.4%) opioid-related deaths, along with 873 matched controls. Psychotropic drug use was associated with a two fold increased risk of opioid-related death (adjusted odds ratio (OR) 2.0; 95% confidence interval (CI) 1.2 to 3.5). Specifically, benzodiazepines (adjusted OR 1.6; 95% CI 1.1 to 2.5) and antipsychotics (adjusted OR 23; 95% Cl 1.5 to 3.5) were independently associated with opioid-related death. Other associated factors included chronic lung disease (adjusted OR 1.7; 95% C11.2 to 2.6), an alcohol use disorder (adjusted OR 1.9; 95% Cl 1.2 to 32), mood disorders (adjusted OR 1.8; 95% CI 1.0 to 3.2), and a history of heart disease (adjusted OR 5.3; 95% Cl 2.0 to 14.0). Psychotropic drug use is associated with opioid-related death in patients receiving methadone. Mindfulness of these factors may reduce the risk of death among methadone recipients. (C) 2015 The Authors. Published by Elsevier Inc.