Postsurgical prescriptions for opioid naive patients and association with overdose and misuse: retrospective cohort study
Postsurgical prescriptions for opioid naive patients and association with overdose and misuse: retrospective cohort study
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DOI：
10.1136/bmj.j5790
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发表时间：
2018-01-17
影响因子：
105.7
通讯作者：
Kohane, Isaac
中科院分区：
文献类型：
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作者：
Brat, Gabriel A.;Agniel, Denis;Kohane, Isaac
目的量化手术后不同阿片类药物处方模式对未使用阿片类药物的人群的依赖、过量或滥用的影响。设计回顾性队列研究。设置来自 2008 年至 2016 年间 37 651 619 名商业保险患者的链接医疗和药房管理数据库的手术索赔。参与者 1 015 116 名未使用阿片类药物的患者接受手术。 主要观察指标 出院后口服阿片类药物的使用情况，按补充量、总剂量和使用持续时间定义。主要结局是通过阿片类药物依赖、滥用或过量的诊断代码识别出滥用的复合结果。 结果 568 612 名患者 (56.0%) 术后接受阿片类药物治疗，并为 5906 名患者确定了滥用代码（0.6%，每 10 万人年 183 人）。阿片类药物使用的总持续时间是滥用的最强预测因素，每次补充和额外使用阿片类药物一周，调整后的误用率增加 44.0%（95% 置信区间 40.8% 至 47.2%，P<0.001），危险增加 19.9%（18.5% 至 21.4%，P<0.001）。结论：阿片类药物处方的每次补充和周数与未使用阿片类药物的患者中阿片类药物滥用的大幅增加相关。这项研究的数据表明，处方的持续时间而不是剂量与术后早期的最终误用更为密切相关。该分析量化了处方选择与阿片类药物滥用之间的关联，并确定了可能产生影响的杠杆。
OBJECTIVETo quantify the effects of varying opioid prescribing patterns after surgery on dependence, overdose, or abuse in an opioid naive population.DESIGNRetrospective cohort study.SETTINGSurgical claims from a linked medical and pharmacy administrative database of 37 651 619 commercially insured patients between 2008 and 2016.PARTICIPANTS1 015 116 opioid naive patients undergoing surgery.MAIN OUTCOME MEASURESUse of oral opioids after discharge as defined by refills and total dosage and duration of use. The primary outcome was a composite of misuse identified by a diagnostic code for opioid dependence, abuse, or overdose.RESULTS568 612 (56.0%) patients received postoperative opioids, and a code for abuse was identified for 5906 patients (0.6%, 183 per 100 000 person years). Total duration of opioid use was the strongest predictor of misuse, with each refill and additional week of opioid use associated with an adjusted increase in the rate of misuse of 44.0% (95% confidence interval 40.8% to 47.2%, P< 0.001), and 19.9% increase in hazard (18.5% to 21.4%, P< 0.001), respectively.CONCLUSIONSEach refill and week of opioid prescription is associated with a large increase in opioid misuse among opioid naive patients. The data from this study suggest that duration of the prescription rather than dosage is more strongly associated with ultimate misuse in the early postsurgical period. The analysis quantifies the association of prescribing choices on opioid misuse and identifies levers for possible impact.