Institute for Clinical Evaluative Sciences, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
JAMA Intern Med. 2013 Feb 11;173(3):196-201. doi: 10.1001/2013.jamainternmed.733.
Use of opioids may predispose drivers to road trauma, yet the effect of opioid dose on this association is unknown.
We conducted a population-based nested case-control study of patients aged 18 to 64 years who received at least 1 publicly funded prescription for an opioid from April 1, 2003, through March 31, 2011. Cases were defined as having an emergency department visit related to road trauma. Patients without road trauma served as a control group matched to cases by age, sex, index year, prior road trauma, and a disease risk index. We compared the risk of road trauma among patients treated with doses of opioids ranging from very low to very high (<20 to ≥200 morphine equivalents daily). In a subgroup analysis, we stratified our analysis by driver status.
Among 549 878 eligible adults, we identified 5300 cases with road trauma and matched an equal number of controls. Multivariate adjustment yielded no significant association between escalating opioid dose and odds of road trauma (adjusted odds ratio ranged between 1.00 and 1.09). However, a significant association between opioid dose and road trauma was observed among drivers. Compared with very low opioid doses, drivers prescribed low doses had a 21% increased odds of road trauma (adjusted odds ratio, 1.21 [95% CI, 1.02-1.42]); those prescribed moderate doses, 29% increased odds (1.29 [1.06-1.57]); those prescribed high doses, 42% increased odds (1.42 [1.15-1.76]); and those prescribed very high doses, 23% increased odds (1.23 [1.02-1.49]).
Among drivers prescribed opioids, a significant relationship exists between drug dose and risk of road trauma. This association is distinct and does not appear with passengers, pedestrians, and others injured in road trauma.
使用阿片类药物可能使驾驶员容易发生道路创伤，但阿片类药物剂量对这种关联的影响尚不清楚。
我们开展了一项基于人群的巢式病例对照研究，纳入了 2003 年 4 月 1 日至 2011 年 3 月 31 日期间年龄在 18 至 64 岁之间、至少接受过 1 次公共资金支付的阿片类药物处方的患者。病例定义为因道路创伤而到急诊就诊的患者。无道路创伤的患者作为对照组，通过年龄、性别、索引年、既往道路创伤和疾病风险指数与病例相匹配。我们比较了接受从极低剂量到极高剂量（<20 至≥200 吗啡当量/天）的阿片类药物治疗的患者发生道路创伤的风险。在亚组分析中，我们根据驾驶员状况对分析进行分层。
在 549878 名符合条件的成年人中，我们共确定了 5300 例道路创伤病例和 5300 例匹配的对照组。多变量调整后，阿片类药物剂量的增加与道路创伤的几率之间无显著关联（调整后的比值比在 1.00 至 1.09 之间）。然而，在驾驶员中观察到阿片类药物剂量与道路创伤之间存在显著关联。与极低剂量的阿片类药物相比，低剂量处方的驾驶员发生道路创伤的几率增加了 21%（调整后的比值比，1.21[95%CI，1.02-1.42]）；中剂量处方的驾驶员几率增加了 29%（1.29[1.06-1.57]）；高剂量处方的驾驶员几率增加了 42%（1.42[1.15-1.76]）；极高剂量处方的驾驶员几率增加了 23%（1.23[1.02-1.49]）。
在接受阿片类药物处方治疗的驾驶员中，药物剂量与道路创伤风险之间存在显著关系。这种关联是独特的，并且与其他因道路创伤而受伤的乘客、行人等不同。
