Patterns and trajectories associated with overdose in patients co-prescribed opioids and benzodiazepines

与同时服用阿片类药物和苯二氮卓类药物的患者服用过量相关的模式和轨迹

• 批准号: 10579664
• 负责人: Joshua J Fenton
• 金额: $ 35万
• 依托单位: UNIVERSITY OF CALIFORNIA AT DAVIS
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-30 至 2025-09-29
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10579664
• 关键词: Patterns; trajectories; associated; overdose; patients

PROJECT SUMMARY Despite prevention efforts and reduced opioid prescribing, U.S. overdose rates continue to rise. Millions of patients prescribed opioids for chronic pain are co-prescribed benzodiazepines, which heighten overdose risk. However, tapering either opioids or benzodiazepines may also increase overdose and mental health risks, and clinicians lack evidence-based guidance about how to safely reduce risk in patients who are co- prescribed opioids with benzodiazepines. Rates of fatal and non-fatal overdose involving prescribed opioids or benzodiazepines combined with illicit opioids or psychostimulants are also rapidly increasing. The specific aims of this proposed study are: Aim 1) To identify risk and protective factors, prescribing patterns, and trajectories associated with progression to long-term benzodiazepine use among patients prescribed long- term opioids. This aim addresses root causes of long-term opioid-benzodiazepine co-prescription. Aim 2) To identify risk and protective factors, prescribing patterns, and trajectories associated with overdose involving prescription opioids or benzodiazepines among patients co-prescribed long-term opioids and benzodiazepines. Findings from this Aim will inform prescription overdose prevention efforts in the large population of patients who are co-prescribed opioids and benzodiazepines. Aim 3) To identify risk and protective factors, prescribing patterns, and trajectories associated with overdose involving either illicit opioids or psychostimulants among patients co-prescribed long-term opioids and benzodiazepines. This Aim will identify factors that may prevent the progression from long-term use of prescribed opioids and benzodiazepines to use of illicit opioids or stimulants. We will accomplish these aims by conducting retrospective cohort studies using two large, complementary data sources: 1) the California Prescription Drug Monitoring Program (PDMP) data linked to death certificates, and 2) the OptumLabs Data Warehouse, a national claims data source representing over 20% of the U.S. commercial and Medicare Advantage market. As the PDMP are linked to death records, the California statewide analyses will focus on fatal overdoses, while the OptumLabs claims analyses will focus on non-fatal overdoses. By capitalizing on the statistical power achieved by these large data sources, this project will elucidate risk and protective factors, drug-use patterns, and trajectories associated with initiation of benzodiazepines among patients prescribed long-term opioids and will identify factors associated with risk of overdose from prescribed opioids, benzodiazepines, or illicit opioids or psychostimulants. Findings will richly inform clinical or policy interventions and guidelines to prevent initial benzodiazepine-opioid co-prescribing and to mitigate overdose risk in patients with established co-prescriptions.

项目摘要 尽管采取了预防措施并减少了阿片类药物的处方，但美国的过量使用率仍在继续上升。数百万 开阿片类药物治疗慢性疼痛的患者同时开苯二氮卓类药物， 风险然而，逐渐减少阿片类药物或苯二氮卓类药物也可能增加过量和心理健康 风险，临床医生缺乏关于如何安全地降低并发症患者风险的循证指南， 处方阿片类药物和苯二氮卓类药物。涉及处方阿片类药物的致死性和非致死性过量发生率 或苯二氮卓类药物与非法类阿片或精神兴奋剂混合使用的情况也在迅速增加。具体 这项研究的目的是：目的1）确定风险和保护因素，处方模式， 与长期服用苯二氮卓类药物的患者进展为长期使用苯二氮卓类药物相关的轨迹 术语阿片类药物这一目标解决了长期合用阿片类药物和苯二氮卓类药物的根本原因。目标2） 确定风险和保护因素，处方模式和与过量相关的轨迹， 处方阿片类药物或苯二氮卓类药物的患者中， 苯二氮卓类从这个目标的调查结果将通知处方过量预防工作的大 联合处方阿片类药物和苯二氮卓类药物的患者人群。（3）识别风险， 保护因素，处方模式，以及与涉及非法药物过量相关的轨迹 长期服用阿片类药物和苯二氮卓类药物的患者使用阿片类药物或精神兴奋剂。这一目标 将确定可能阻止长期使用处方阿片类药物进展的因素， 苯二氮卓类药物与使用非法阿片类药物或兴奋剂之间的关系。我们将通过以下方式实现这些目标： 回顾性队列研究，使用两个大型互补数据源：1）加州处方 与死亡证明相关的药物监测计划（PIMCO）数据，以及2）OptumLabs数据仓库， 一个全国性的索赔数据源，占美国商业和医疗保险优势的20%以上 市场由于死亡率与死亡记录有关，加州全州范围的分析将集中在致命的 OptumLabs声称分析将集中在非致命性过量。通过利用 通过这些大型数据源获得的统计能力，该项目将阐明风险和保护因素， 药物使用模式和处方患者中与开始使用苯二氮卓类药物相关的轨迹 长期阿片类药物，并将确定与处方阿片类药物过量风险相关的因素， 苯二氮卓类或非法阿片类或精神兴奋剂。研究结果将丰富地告知临床或政策 预防最初苯二氮卓类阿片合并处方和减轻过量的干预措施和准则 已确定联合处方的患者的风险。