Initiation of Opioid Prescription and Risk of Suicidal Behavior Among Youth and Young Adults.
Initiation of Opioid Prescription and Risk of Suicidal Behavior Among Youth and Young Adults.
复制标题
DOI：
10.1542/peds.2020-049750
复制
发表时间：
2022-03-01
期刊：
影响因子：
8
通讯作者：
Quinn, Patrick D.
中科院分区：
文献类型：
--
作者：
Fine, Kimberly L.;Rickert, Martin E.;O'Reilly, Lauren M.;Sujan, Ayesha C.;Boersma, Katja;Chang, Zheng;Franck, Johan;Lichtenstein, Paul;Larsson, Henrik;D'Onofrio, Brian M.;Quinn, Patrick D.
阿片类药物参与自杀死亡的比例越来越高。本研究探讨了阿片类镇痛药处方开始与青年和年轻人自杀行为之间的关联。我们分析了1895984名年龄在9-29岁之间的瑞典人口登记数据，这些人之前没有记录阿片类药物处方。我们确定了从2007年1月起分发的阿片类药物处方，以及临床诊断的自我伤害行为和自杀死亡，直到2013年12月。我们首先比较了启动者与人口统计学匹配的非启动者。为了解释混杂因素，我们采用了一种活性对照药物设计，该设计检查了阿片类药物启动者相对于处方非甾体抗炎药（NSAID）启动者的自杀行为，同时采用个体和家族协变量进行治疗概率加权。在该队列中，201433人开始使用阿片类药物处方。相对于人口统计学匹配的非启动者，启动者（N=180 808）的自杀行为风险增加一倍以上（风险比=2.64; 95%置信区间[CI]：2.47-2.81）。然而，在活性对照药物设计中，阿片类药物引发剂（N=86 635）与NSAID启动者相比，自杀行为的风险仅相对高出19（N=255 096;风险比=1.19; 95% CI：1.11-1.28），相当于加权5年累积发生率为2.2%（95% CI：2.1%-2.4%）和1.9%（95% CI：1.9%-2.0%）。大多数敏感性分析产生了可比的结果。在接受药物疼痛管理的年轻人中，阿片类药物的启动可能对自杀行为风险的升高只有很小的贡献。在权衡阿片类药物启动的益处和危害时，我们的研究结果表明，自杀行为的风险增加可能不是一个主要问题。这项研究使用瑞典全国范围的数据，研究了青年和年轻人开始使用阿片类镇痛药处方与自杀行为风险之间的关系。
Opioids are involved in an increasing proportion of suicide deaths. This study examined the association between opioid analgesic prescription initiation and suicidal behavior among youth and young adults. We analyzed Swedish population-register data on 1 895 984 individuals ages 9-29 years without prior recorded opioid prescriptions. We identified opioid prescriptions dispensed from January 2007 onward and clinically diagnosed self-injurious behavior and death by suicide through December 2013. We first compared initiators with demographically matched non-initiators. To account for confounding, we applied an active comparator design, which examined suicidal behavior among opioid initiators relative to prescription nonsteroidal anti-inflammatory drug (NSAID) initiators while inverse-probability-of-treatment weighting with individual and familial covariates. Among the cohort, 201 433 individuals initiated opioid prescription. Relative to demographically matched non-initiators, initiators (N=180 808) had more than doubled risk of incident suicidal behavior (hazard ratio=2.64; 95% confidence interval [CI]: 2.47-2.81). However, in the active comparator design, opioid initiators (N=86 635) had only 19% relatively greater risk of suicidal behavior compared with NSAID initiators (N=255 096; hazard ratio=1.19; 95% CI: 1.11-1.28), corresponding to a weighted 5-year cumulative incidence of 2.2% (95% CI: 2.1%-2.4%) for opioid and 1.9% (95% CI: 1.9%-2.0%) for NSAID initiators. Most sensitivity analyses produced comparable results. Opioid initiation may make only a small contribution to the elevated risk of suicidal behavior among young people receiving pharmacologic pain management. In weighing benefits and harms of opioid initiation, our results suggest that increased risk of suicidal behavior may not be a major concern. Using nationwide Swedish data, this study examined the association between initiation of opioid analgesic prescription and risk of suicidal behavior among youth and young adults.
登录
查看更多内容
影响因子：
2
作者：
Austin PC
通讯作者：
Austin PC
影响因子：
4.7
作者：
Brodsky BS;Spruch-Feiner A;Stanley B
通讯作者：
Stanley B
影响因子：
4.2
作者：
Abrahamsson, Tove;Berge, Jonas;Hakansson, Anders
通讯作者：
Hakansson, Anders
影响因子：
17.7
作者：
Fazel, Seena;Grann, Martin
通讯作者：
Grann, Martin
影响因子：
3.7
作者：
Bohnert, Amy S. B.;McCarthy, John F.;Blow, Frederic C.
通讯作者：
Blow, Frederic C.