Quest Diagnostics, Madison, New Jersey, USA.
J Addict Med. 2017 Nov/Dec;11(6):420-426. doi: 10.1097/ADM.0000000000000354.
Recently, more than 63% of the 52,404 drug overdose deaths in the United States involved heroin and opioid pain medications. More than 30% of opioid-related deaths also involved benzodiazepines. Previous studies examining the extent of concurrent opioid and benzodiazepine use have relied on prescription data. To gain fuller insight into the extent of the concurrent use problem, we analyzed opioid and benzodiazepine prescription patterns in the context of drug testing results.
All specimens from patients that were prescribed at least 1 drug and were tested for both opioids and benzodiazepines by a national reference laboratory were included. This resulted in an analytical set of 231,228 sets of test results from 144,535 patients with diverse demographic factors being tested in a variety of health care settings.
Laboratory test results indicated concurrent use of opioids and benzodiazepines in over 25% of patients. In 52% of test results with evidence of concurrent use, 1 drug class was prescribed and the other was non-prescribed. Nearly 1 in 5 specimens (19%) testing positive for prescribed opioids also tested positive for non-prescribed benzodiazepines. Over 15% of specimens with prescribed benzodiazepines also demonstrated non-prescribed opioid use.
The extent of concurrent use of benzodiazepines and opioids, particularly non-prescribed use, suggests the need for more effective clinician assessment and intervention. The results support the Centers for Disease Control and Prevention opioid prescribing guidelines that drug testing occur before and periodically throughout opioid use and suggest that this testing should be extended to patients prescribed benzodiazepines as well.
最近，美国超过 63%的 52404 例药物过量死亡涉及海洛因和阿片类止痛药。超过 30%的阿片类药物相关死亡也涉及苯二氮䓬类药物。以前研究阿片类药物和苯二氮䓬类药物同时使用程度的研究依赖于处方数据。为了更全面地了解同时使用问题的程度，我们在药物检测结果的背景下分析了阿片类药物和苯二氮䓬类药物的处方模式。
所有至少开了一种药物且由国家参考实验室同时检测阿片类药物和苯二氮䓬类药物的患者的样本都包括在内。这产生了一个由 144535 名具有不同人口统计学因素的患者组成的分析数据集，这些患者在各种医疗保健环境中接受了测试。
实验室检测结果表明，超过 25%的患者同时使用阿片类药物和苯二氮䓬类药物。在 52%的有同时使用证据的检测结果中，1 种药物类别是开处方的，而另一种是非处方的。近 19%的检测结果呈阳性的阿片类药物处方样本也检测出非处方苯二氮䓬类药物阳性。超过 15%的苯二氮䓬类药物处方样本也显示出非处方阿片类药物的使用。
苯二氮䓬类药物和阿片类药物同时使用的程度，特别是非处方使用的程度，表明需要更有效的临床医生评估和干预。结果支持疾病控制与预防中心的阿片类药物处方指南，即在使用阿片类药物之前和期间定期进行药物检测，并建议将此检测扩展到开处方苯二氮䓬类药物的患者。
