Turner Barbara J, Liang Yuanyuan
Division of General Internal Medicine, Department of Medicine, University of Texas Health Science Center San Antonio (UTHSCSA), 7411 John Smith Rd. Suite 1050, San Antonio, TX, 78229, USA,
J Gen Intern Med. 2015 Aug;30(8):1081-96. doi: 10.1007/s11606-015-3199-4. Epub 2015 Feb 4.
Opioid analgesics and other psychoactive drugs may pose an even greater risk for drug overdose in persons with mental health disorders.
The purpose of this study was to examine interactions of filled prescriptions for opioids, benzodiazepines, antidepressants, and zolpidem with mental health disorders in regard to drug overdose.
The study was a retrospective cohort review.
Subjects were national HMO beneficiaries aged 18-64 years, enrolled at least 1 year (01/2009 to 07/2012), who filled at least two prescriptions for Schedule II or III opioids for non-cancer pain.
The outcome was the first inpatient or outpatient drug overdose after the first filled opioid prescription. Predictors were calculated in 6-month intervals and exactly 6 months before a drug overdose: opioid use (mean daily morphine-equivalent dose), benzodiazepine use (days' supply), antidepressant use (days' supply), zolpidem use (days' supply), mental health disorders (depression, anxiety/PTSD, psychosis), pain-related conditions, and substance use disorders (alcohol, other drug).
A total of 1,385 (0.67%) subjects experienced a drug overdose (incidence rate 421/100,000 person-years). The adjusted odds ratios (AOR) for overdose among all subjects rose monotonically with daily opioid dose, but highest (AOR = 7.06) for persons with depression and a high opioid dose (≥100 mg) versus no depression or opioid use. Longer-term antidepressants (91-180 days) were protective for persons with depression, with 20% lower AORs for overdose versus short-term (1-30 days) or none. For persons without depression, the AORs of overdose were increased for antidepressant use, but greatest (AOR = 1.98) for short-term use versus none. The AORs of overdose increased with the duration of benzodiazepine therapy among all subjects, with over 2.5-fold higher AORs for 91-180 days versus none.
Opioids and longer-duration benzodiazepines were associated with drug overdose among all subjects, but opioid risk was greatest for persons with depression. Antidepressant use > 90 days reduced the odds of overdose for persons with depression, but all antidepressant use increased the risk for persons without depression.
阿片类镇痛药和其他精神活性药物可能会给患有精神疾病的人带来更高的药物过量风险。
本研究旨在探讨阿片类药物、苯二氮䓬类药物、抗抑郁药和唑吡坦的处方用量与精神疾病在药物过量方面的相互作用。
该研究为回顾性队列研究。
研究对象为年龄在18 - 64岁之间、于2009年1月至2012年7月至少参保1年的全国性健康维护组织（HMO）受益人，他们至少开具过两张用于非癌性疼痛的II类或III类阿片类药物处方。
观察指标为首次开具阿片类药物处方后首次发生的住院或门诊药物过量情况。预测指标在药物过量前6个月的间隔期以及恰好6个月时进行计算：阿片类药物使用情况（平均每日吗啡当量剂量）、苯二氮䓬类药物使用情况（供应天数）、抗抑郁药使用情况（供应天数）、唑吡坦使用情况（供应天数）、精神疾病（抑郁症、焦虑症/创伤后应激障碍、精神病）、疼痛相关疾病以及物质使用障碍（酒精、其他药物）。
共有1385名（0.67%）研究对象发生了药物过量（发病率为421/100,000人年）。所有研究对象中，药物过量的调整优势比（AOR）随每日阿片类药物剂量单调上升，但对于患有抑郁症且阿片类药物剂量高（≥100毫克）的人而言最高（AOR = 7.06），而未患抑郁症或未使用阿片类药物的人则较低。长期使用抗抑郁药（91 - 180天）对患有抑郁症的人具有保护作用，与短期（1 - 30天）使用或未使用相比，药物过量的AOR降低了20%。对于未患抑郁症的人，使用抗抑郁药会增加药物过量的AOR，但短期使用时最高（AOR = 1.98），未使用时则较低。在所有研究对象中，药物过量的AOR随苯二氮䓬类药物治疗持续时间增加而升高，使用91 - 180天的AOR比未使用时高出2.5倍以上。
在所有研究对象中，阿片类药物和较长疗程的苯二氮䓬类药物与药物过量有关，但抑郁症患者使用阿片类药物的风险最大。使用抗抑郁药超过90天可降低抑郁症患者药物过量的几率，但所有抗抑郁药的使用都会增加未患抑郁症患者的风险。
