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 尽管预防努力并减少了阿片类药物的处方，但美国过量率仍在上升。数百万 患者开处方用于慢性疼痛的阿片类药物是共同处方的苯二氮卓类药物，可增强过量药物 风险。但是，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 风险和临床医生缺乏有关如何安全降低共同患者风险的基于证据的指导 开处方的阿片类药物和苯二氮卓类药物。涉及处方阿片类药物的致命和非致命过量剂量 或苯二氮卓类药物与非法阿片类药物或精神刺激剂的结合也正在迅速增加。具体 这项拟议研究的目的是：目标1）确定风险和保护因素，处方模式以及 与长期苯二氮卓使用相关的轨迹在开处方长期使用的患者中 术语阿片类药物。该目的解决了长期阿片类苯并二氮杂的共同处方的根本原因。目标2） 识别风险和保护因素，处方模式以及与涉及过量相关的轨迹 处方阿片类药物或苯二氮卓类药物在患者共同处方的长期阿片类药物和 苯二氮卓。此目标的发现将为大型处方预防处方的预防措施。 共同处方阿片类药物和苯二氮卓类药物的人群。目标3）确定风险和 保护因素，处方模式和与涉及任何非法的过量相关的轨迹 患者共同处方长期阿片类药物和苯二氮卓类药物中的阿片类药物或精神刺激药。这个目标 将确定可能阻止长期使用规定的阿片类药物的因素和 苯二氮卓类药物使用非法阿片类药物或兴奋剂。我们将通过进行这些目标来实现这些目标 回顾性队列研究使用两个大型补充数据来源：1）加利福尼亚处方 药物监测计划（PDMP）链接到死亡证明的数据，以及2）optumlabs数据仓库， 国家索赔数据源，占美国商业和医疗保险优势的20％以上 市场。由于PDMP与死亡记录有关，因此加利福尼亚州全州的分析将重点放在致命上 服用过量，而optumlabs声称分析将集中于非致命性过量。通过利用 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， 药物使用模式和与苯二氮卓类药物的启动相关的轨迹 长期阿片类药物，将确定与处方阿片类药物过量的风险相关的因素， 苯二氮卓类药物或非法阿片类药物或精神刺激剂。调查结果将为临床或政策提供丰富的信息 干预措施和准则，以防止初始苯二氮卓类阿片类药物共同处方并减轻过量 具有既定共同处置的患者的风险。