Garg Renu K, Fulton-Kehoe Deborah, Franklin Gary M
Departments of *Epidemiology †Environmental and Occupational Health Sciences ‡Health Services ∥Neurology, University of Washington, Seattle §Washington State Department of Labor and Industries, Olympia, WA.
Med Care. 2017 Jul;55(7):661-668. doi: 10.1097/MLR.0000000000000738.
The Centers for Disease Control and Prevention recognizes Medicaid as a high-risk population for fatal opioid overdose. Further research is needed to identify factors that put Medicaid patients at increased risk.
To determine whether patterns of opioid use are associated with risk of opioid-related mortality among opioid users.
This is a retrospective cohort study.
In total, 150,821 noncancer pain patients aged 18-64 years with ≥1 opioid prescription, April 2006 to December 2010, Washington Medicaid.
Average daily dose (morphine equivalents), opioid schedule/duration of action, sedative-hypnotic use.
Compared with patients at 1-19 mg/d, risk of opioid overdose death significantly increased at 50-89 mg/d [adjusted hazard ratio (aHR), 2.3; 95% confidence interval (CI), 1.4-4.1], 90-119 mg/d (aHR, 4.0; 95% CI, 2.2-7.3), 120-199 mg/d (aHR, 3.8; 95% CI, 2.1-6.9), and ≥200 mg/d (aHR, 4.9; 95% CI, 2.9-8.1). Patients using long-acting plus short-acting Schedule II opioids had 4.7 times the risk of opioid overdose death than non-Schedule II opioids alone (aHR, 4.7; 95% CI, 3.3-6.9). Sedative-hypnotic use compared with nonuse was associated with 6.4 times the risk of opioid overdose death (aHR, 6.4; 95% CI, 5.0-8.4). Risk was particularly high for opioids combined with benzodiazepines and skeletal muscle relaxants (aHR, 12.6; 95% CI, 8.9-17.9). Even at opioid doses 1-19 mg/d, patients using sedative-hypnotics concurrently had 5.6 times the risk than patients without sedative-hypnotics (aHR, 5.6; 95% CI, 1.6-19.3).
Our findings support Federal guideline-recommended dosing thresholds in opioid prescribing. Concurrent sedative-hypnotic use even at low opioid doses poses substantially greater risk of opioid overdose.
美国疾病控制与预防中心认为医疗补助计划的参保者是阿片类药物致命过量服用的高危人群。需要进一步研究以确定使医疗补助计划患者风险增加的因素。
确定阿片类药物使用模式是否与阿片类药物使用者中阿片类药物相关死亡率风险有关。
这是一项回顾性队列研究。
2006年4月至2010年12月期间，华盛顿医疗补助计划中共有150,821名年龄在18 - 64岁、有≥1份阿片类药物处方的非癌症疼痛患者。
平均日剂量（吗啡当量）、阿片类药物的类别/作用持续时间、镇静催眠药的使用情况。
与每日剂量为1 - 19毫克的患者相比，每日剂量为50 - 89毫克时，阿片类药物过量死亡风险显著增加[调整后风险比（aHR），2.3；95%置信区间（CI），1.4 - 4.1]，90 - 119毫克时（aHR，4.0；95% CI，2.2 - 7.3），120 - 199毫克时（aHR，3.8；95% CI，2.1 - 6.9），以及≥200毫克时（aHR，4.9；95% CI，2.9 - 8.1）。使用长效加短效II类阿片类药物的患者阿片类药物过量死亡风险是仅使用非II类阿片类药物患者的4.7倍（aHR，4.7；95% CI，3.3 - 6.9）。与未使用镇静催眠药相比，使用镇静催眠药与阿片类药物过量死亡风险增加6.4倍相关（aHR，6.4；95% CI，5.0 - 8.4）。阿片类药物与苯二氮䓬类药物和骨骼肌松弛剂联合使用时风险特别高（aHR，12.6；95% CI，8.9 - 17.9）。即使在阿片类药物剂量为1 - 19毫克/天时，同时使用镇静催眠药的患者风险也是未使用镇静催眠药患者的5.6倍（aHR，5.6；95% CI，1.6 - 19.3）。
我们的研究结果支持联邦指南推荐的阿片类药物处方剂量阈值。即使在低阿片类药物剂量下同时使用镇静催眠药也会带来显著更高的阿片类药物过量风险。
