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阿片类药物处方模式与阿片类药物过量相关死亡之间的关联。

Association between opioid prescribing patterns and opioid overdose-related deaths.

机构信息

Department of Veterans Affairs, Health Services Research & Development Center of Excellence, Ann Arbor, Michigan, USA.

出版信息

JAMA. 2011 Apr 6;305(13):1315-21. doi: 10.1001/jama.2011.370.

DOI:10.1001/jama.2011.370

PMID:21467284

Abstract

CONTEXT

The rate of prescription opioid-related overdose death increased substantially in the United States over the past decade. Patterns of opioid prescribing may be related to risk of overdose mortality.

OBJECTIVE

To examine the association of maximum prescribed daily opioid dose and dosing schedule ("as needed," regularly scheduled, or both) with risk of opioid overdose death among patients with cancer, chronic pain, acute pain, and substance use disorders.

DESIGN

Case-cohort study.

SETTING

Veterans Health Administration (VHA), 2004 through 2008.

PARTICIPANTS

All unintentional prescription opioid overdose decedents (n = 750) and a random sample of patients (n = 154,684) among those individuals who used medical services in 2004 or 2005 and received opioid therapy for pain. Main Outcome Measure Associations of opioid regimens (dose and schedule) with death by unintentional prescription opioid overdose in subgroups defined by clinical diagnoses, adjusting for age group, sex, race, ethnicity, and comorbid conditions.

RESULTS

The frequency of fatal overdose over the study period among individuals treated with opioids was estimated to be 0.04%.The risk of overdose death was directly related to the maximum prescribed daily dose of opioid medication. The adjusted hazard ratios (HRs) associated with a maximum prescribed dose of 100 mg/d or more, compared with the dose category 1 mg/d to less than 20 mg/d, were as follows: among those with substance use disorders, adjusted HR = 4.54 (95% confidence interval [CI], 2.46-8.37; absolute risk difference approximation [ARDA] = 0.14%); among those with chronic pain, adjusted HR = 7.18 (95% CI, 4.85-10.65; ARDA = 0.25%); among those with acute pain, adjusted HR = 6.64 (95% CI, 3.31-13.31; ARDA = 0.23%); and among those with cancer, adjusted HR = 11.99 (95% CI, 4.42-32.56; ARDA = 0.45%). Receiving both as-needed and regularly scheduled doses was not associated with overdose risk after adjustment.

CONCLUSION

Among patients receiving opioid prescriptions for pain, higher opioid doses were associated with increased risk of opioid overdose death.

摘要

背景

在过去的十年中，美国处方类阿片类药物相关用药过量死亡人数大幅增加。阿片类药物的使用模式可能与用药过量死亡率有关。

目的

研究最大处方日剂量和剂量方案（按需、定期或两者兼有）与癌症、慢性疼痛、急性疼痛和物质使用障碍患者阿片类药物用药过量死亡风险的关系。

设计

病例-队列研究。

设置

退伍军人健康管理局（VHA），2004 年至 2008 年。

参与者

所有非故意处方类阿片类药物用药过量死亡者（n = 750）和 2004 年或 2005 年使用医疗服务并接受疼痛阿片类药物治疗的个人中随机抽取的患者（n = 154684）。

主要观察指标

按临床诊断定义的亚组，调整年龄组、性别、种族、民族和合并症后，阿片类药物方案（剂量和方案）与非故意处方类阿片类药物用药过量死亡的相关性。

结果

在接受阿片类药物治疗的个体中，研究期间用药过量的致死率估计为 0.04%。用药过量死亡的风险与阿片类药物药物的最大处方日剂量直接相关。与 1 毫克/天至 20 毫克/天剂量类别相比，最大处方剂量为 100 毫克/天或更高剂量的调整后的危害比（HR）如下：物质使用障碍患者，调整后的 HR = 4.54（95%置信区间[CI]，2.46-8.37；绝对风险差异逼近[ARDA] = 0.14%）；慢性疼痛患者，调整后的 HR = 7.18（95% CI，4.85-10.65；ARDA = 0.25%）；急性疼痛患者，调整后的 HR = 6.64（95% CI，3.31-13.31；ARDA = 0.23%）；癌症患者，调整后的 HR = 11.99（95% CI，4.42-32.56；ARDA = 0.45%）。调整后，接受按需和定期剂量的患者用药过量风险无关联。