Association of Opioid Overdose With Opioid Prescriptions to Family Members
Association of Opioid Overdose With Opioid Prescriptions to Family Members
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DOI：
10.1001/jamainternmed.2019.1064
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发表时间：
2019-09-01
影响因子：
39
通讯作者：
Gagne, Joshua J.
中科院分区：
文献类型：
--
作者：
Khan, Nazleen F.;Bateman, Brian T.;Gagne, Joshua J.
处方阿片类药物滥用是一个导致过量的公共卫生问题。虽然现有的干预措施的重点是限制处方的高风险患者，个人仍然可以获得处方阿片类药物分发给家庭members.OBJECTIVE要确定阿片类药物处方的家庭成员是否与过量的个人谁自己没有阿片类药物prescription.DESIGN，设置，和参与者我们进行了一项1：4匹配的病例对照研究，从2004年到2015年的医疗保健利用数据，从美国一家大型商业保险公司。符合条件的个人需要至少连续入组12个月，并且数据库中有1名或多名家庭成员。通过基线期后首次阿片类药物过量来确定发生过量的个体，并通过数据库中的时间，日历时间，年龄，性别和家庭单位中的个体数量与对照参与者相匹配。这两组受试者都被限制在没有自己的阿片类药物分配的个人。数据分析从2018年1月至2018年8月进行。EXPOSURES任何先前的阿片类药物分配给家庭成员，总吗啡毫克当量分配给家庭成员，阿片类药物产品dispensed.Main结局和措施的类型阿片类药物过量导致急诊科就诊或住院的个体几率是主要终点。主要分析评估了家庭成员被分配阿片类药物的个人中过量的几率。敏感性分析检查的赔率分层的年龄和时间相对于阿片类药物的分配给家庭members.Results共2303个人谁经历了阿片类药物过量和9212匹配的对照个体进行了鉴定。平均（SD）年龄为23.2（18.1）岁; 1158例受影响个体和4632例对照个体（50.3%）为女性。用药过量病例发生前数据库中的平均（SD）时间为3.2（3.3）年。既往向家庭成员分发阿片类药物与个体用药过量相关（比值比[OR]，2.89 [95% CI，2.59-3.23]）。向家庭成员分发的阿片类药物数量增加与过量的几率之间存在显著的剂量反应相关性（>0-
IMPORTANCE Prescription opioid misuse is a public health problem that leads to overdose. Although existing interventions focus on limiting prescribing to patients at high risk, individuals may still access prescription opioids dispensed to family members.OBJECTIVE To determine whether opioid prescriptions to family members were associated with overdose for individuals who themselves did not have an opioid prescription.DESIGN, SETTING, AND PARTICIPANTS We conducted a 1:4 matched case-control study using health care utilization data from 2004 through 2015 from a large US commercial insurance company. Eligible individuals were required to have at least 12 months of continuous enrollment and 1 or more family members in the database. Individuals who experienced overdose were identified by their first opioid overdose after the baseline period and matched to control participants by time in the database, calendar time, age, sex, and number of individuals in the family unit. Both groups were restricted to individuals with no prior opioid dispensing of their own. Data analysis was conducted from January 2018 to August 2018.EXPOSURES Any prior opioid dispensing to a family member, total morphine milligram equivalents dispensed to family members, and the type of opioid product dispensed.MAIN OUTCOMES AND MEASURES Individual odds of opioid overdose resulting in an emergency department visit or hospitalization were the primary end point. The primary analysis evaluated the odds of overdose among individuals whose family members had been dispensed an opioid. Sensitivity analyses examined the odds stratified by age and timing relative to the dispensing of opioids to family members.RESULTS A total of 2303 individuals who experienced opioid overdose and 9212 matched control individuals were identified. The mean (SD) age was 23.2 (18.1) years; 1158 affected individuals and 4632 control individuals (50.3%) were female. The mean (SD) time in the database before an overdose case was 3.2 (3.3) years. Prior opioid dispensing to family members was associated with individual overdose (odds ratio [OR], 2.89 [95% CI, 2.59-3.23]). There was a significant dose-response association between increasing amounts of opioids dispensed to family members and odds of overdose (>0-