JAMA Intern Med. 2014 May;174(5):796-801. doi: 10.1001/jamainternmed.2013.12711.
From January 1, 2003, through December 31, 2010, drug overdose deaths in Tennessee increased from 422 to 1059 per year. More of these deaths involved prescription opioids than heroin and cocaine combined.
To assess the contribution of certain opioid-prescribing patterns to the risk of overdose death.
DESIGN, SETTING, AND PARTICIPANTS: We performed a matched case-control study that analyzed opioid prescription data from the Tennessee Controlled Substances Monitoring Program (TNCSMP) from January 1, 2007, through December 31, 2011, to identify risk factors associated with opioid-related overdose deaths from January 1, 2009, through December 31, 2010. Case patients were ascertained from death certificate data. Age- and sex-matched controls were randomly selected from among live patients in the TNCSMP.
We defined a high-risk number of prescribers or pharmacies as 4 or more per year and high-risk dosage as a daily mean of more than 100 morphine milligram equivalents (MMEs) per year. The main outcome was opioid-related overdose death.
From January 1, 2007, through December 31, 2011, one-third of the population of Tennessee filled an opioid prescription each year, and opioid prescription rates increased from 108.3 to 142.5 per 100 population per year. Among all patients in Tennessee prescribed opioids during 2011, 7.6% used more than 4 prescribers, 2.5% used more than 4 pharmacies, and 2.8% had a mean daily dosage greater than 100 MMEs. Increased risk of opioid-related overdose death was associated with 4 or more prescribers (adjusted odds ratio [aOR], 6.5; 95% CI, 5.1-8.5), 4 or more pharmacies (aOR, 6.0; 95% CI, 4.4-8.3), and more than 100 MMEs (aOR, 11.2; 95% CI, 8.3-15.1). Persons with 1 or more risk factor accounted for 55% of all overdose deaths.
High-risk use of prescription opioids is frequent and increasing in Tennessee and is associated with increased overdose mortality. Use of prescription drug–monitoring program data to direct risk-reduction measures to the types of patients overrepresented among overdose deaths might reduce mortality associated with opioid abuse.
从 2003 年 1 月 1 日至 2010 年 12 月 31 日，田纳西州的药物过量致死人数从每年 422 人增加到 1059 人。这些死亡人数中有更多涉及处方类阿片，超过了海洛因和可卡因的总和。
评估某些阿片类药物处方模式对过量用药死亡风险的影响。
设计、地点和参与者：我们进行了一项匹配病例对照研究，分析了田纳西州受控物质监测计划（TNCSMP）从 2007 年 1 月 1 日至 2011 年 12 月 31 日的阿片类药物处方数据，以确定与 2009 年 1 月 1 日至 2010 年 12 月 31 日期间与阿片类药物相关的过量用药死亡相关的风险因素。病例患者是从死亡证明数据中确定的。年龄和性别匹配的对照者是从 TNCSMP 中的存活患者中随机选择的。
我们将每年 4 名或以上开处方的医生或药房定义为高危医生或药房，将每日平均用量超过 100 毫克吗啡当量（MME）定义为高危剂量。主要结果是阿片类药物相关的过量用药死亡。
从 2007 年 1 月 1 日至 2011 年 12 月 31 日，田纳西州三分之一的人口每年都开阿片类药物处方，阿片类药物处方率从每年每 100 人 108.3 份增加到 142.5 份。在 2011 年所有使用阿片类药物的田纳西州患者中，7.6%使用了 4 名或以上开处方的医生，2.5%使用了 4 家或以上药房，2.8%的每日平均剂量超过 100 MME。与阿片类药物相关的过量用药死亡风险与使用 4 名或以上开处方的医生（调整后的优势比[OR]，6.5；95%置信区间[CI]，5.1-8.5）、4 家或以上药房（OR，6.0；95%CI，4.4-8.3）和超过 100 MME（OR，11.2；95%CI，8.3-15.1）有关。有 1 个或多个风险因素的人占所有过量死亡人数的 55%。
田纳西州高危使用处方类阿片药物的情况频繁且不断增加，与过量死亡率增加有关。利用处方药物监测计划数据，将减少风险措施针对过量死亡患者中占比过高的类型，可能会降低与阿片类药物滥用相关的死亡率。
