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.

项目总结 尽管采取了预防措施并减少了阿片类药物的处方，但美国的过量服药率仍在继续上升。数以百万计 为慢性疼痛开阿片类药物的患者是联合处方的苯二氮卓类药物，这会加剧过量服药。 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服药和精神健康 风险，临床医生缺乏关于如何安全地降低联合治疗患者风险的循证指导 含有苯二氮卓类药物的处方阿片类药物。涉及处方阿片类药物的致命性和非致命性过量使用率 或者，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在迅速增加。具体的 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 长期服用苯二氮卓类药物的患者进展至长期使用的相关轨迹 术语阿片类药物。这一目的是解决长期使用阿片类药物-苯二氮卓类药物联合处方的根本原因。目标2) 确定与过量用药有关的风险和保护因素、处方模式和轨迹 处方阿片类药物或苯二氮类药物联合长期服用阿片类药物和苯二氮卓类药物的患者 苯二氮卓类。这一目的的发现将为大规模的处方过量预防工作提供参考 同时服用阿片类药物和苯二氮卓类药物的患者人数。目标3)识别风险和 保护性因素、处方模式和与过量用药有关的轨迹 长期服用阿片类药物和苯二氮卓类药物的患者中的阿片类药物或精神刺激剂。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，并 苯二氮卓类药物使用非法类阿片或兴奋剂。我们将通过开展以下工作来实现这些目标 使用两个大型互补数据来源的回溯性队列研究：1)加州处方 与死亡证明相关的药物监测计划(PDMP)数据，以及2)OptomLabs数据仓库， 代表美国商业和医疗保险优势的20%以上的全国性索赔数据来源 市场。由于PDMP与死亡记录有关，加利福尼亚州的全州分析将集中在致命的 过量，而OptomLabs声称分析将集中在非致命的过量。通过利用 通过这些大型数据来源所获得的统计能力，该项目将阐明风险和保护因素， 服用苯二氮卓类药物的患者的药物使用模式和使用轨迹 长期使用阿片类药物，并将查明与处方阿片类药物过量风险有关的因素， 苯二氮类药物，或非法阿片类药物或精神刺激剂。研究结果将为临床或政策提供丰富的信息 预防首次苯二氮卓类阿片类药物联合处方和减少过量使用的干预措施和指南 已有联合处方的患者的风险。