Association of Emergency Department Opioid Initiation With Recurrent Opioid Use
Association of Emergency Department Opioid Initiation With Recurrent Opioid Use
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DOI：
10.1016/j.annemergmed.2014.11.015
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发表时间：
2015-05-01
影响因子：
6.2
通讯作者：
Heard, Kennon
中科院分区：
文献类型：
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作者：
Hoppe, Jason A.;Kim, Howard;Heard, Kennon
研究目的：急性疼痛主诉是急诊科（ED）的常见病。短期阿片类药物被认为对急性疼痛是安全的；然而，收到ED阿片类药物处方后再次使用阿片类药物的风险尚不清楚。我们描述了从急诊科接受阿片类药物处方的急性疼痛患者复发阿片类药物使用的风险。方法：这是一项回顾性队列研究，研究对象是在5个月期间从一家城市学术急诊科出院的所有急性疼痛患者。临床信息与科罗拉多州处方药监测项目的数据相关联。我们比较了未服用阿片类药物的患者（就诊前一年没有阿片类药物处方），他们服用了阿片类药物处方，或接受了处方但没有服用，与没有服用处方的患者进行了比较。主要结果是阿片类药物复发率，定义为在急诊科就诊一周年前后60天内服用阿片类药物。结果：治疗急性疼痛患者4800例；其中，52%是阿片类药物新手，48%接受过阿片类药物处方。在所有阿片类药物初始患者中，775名（31%）接受并填写了阿片类药物处方，299名（12%）继续反复使用。对于服用阿片类药物的新手患者，与未服用阿片类药物的患者相比，复发使用阿片类药物的调整优势比为1.8（95%置信区间为1.3至2.3）。对于接受处方但未服用阿片类药物的新手患者，与未接受处方的患者相比，复发使用阿片类药物的调整优势比为0.8（95%置信区间为0.5至1.3）。结论：首次使用阿片类药物治疗急性疼痛的ED患者在1年后再次使用阿片类药物的风险增加。
Study objective: Acute pain complaints are commonly treated in the emergency department (ED). Short courses of opioids are presumed to be safe for acute pain; however, the risk of recurrent opioid use after receipt of an ED opioid prescription is unknown. We describe the risk of recurrent opioid use in patients receiving an opioid prescription from the ED for an acute painful condition.Methods: This is a retrospective cohort study of all patients discharged from an urban academic ED with an acute painful condition during a 5-month period. Clinical information was linked to data from Colorado's prescription drug monitoring program. We compared opioid-naive patients (no opioid prescription during the year before the visit) who filled an opioid prescription or received a prescription but did not fill it to those who did not receive a prescription. The primary outcome was the rate of recurrent opioid use, defined as filling an opioid prescription within 60 days before or after the first anniversary of the ED visit.Results: Four thousand eight hundred one patients were treated for an acute painful condition; of these, 52% were opioid naive and 48% received an opioid prescription. Among all opioid-naive patients, 775 (31%) received and filled an opioid prescription, and 299 (12%) went on to recurrent use. For opioid-naive patients who filled a prescription compared with those who did not receive a prescription, the adjusted odds ratio for recurrent use was 1.8 (95% confidence interval 1.3 to 2.3). For opioid-naive patients who received a prescription but did not fill it compared with those who did not receive a prescription, the adjusted odds ratio for recurrent use was 0.8 (95% confidence interval 0.5 to 1.3).Conclusion: Opioid-naive ED patients prescribed opioids for acute pain are at increased risk for additional opioid use at 1 year.