Brat Gabriel A, Agniel Denis, Beam Andrew, Yorkgitis Brian, Bicket Mark, Homer Mark, Fox Kathe P, Knecht Daniel B, McMahill-Walraven Cheryl N, Palmer Nathan, Kohane Isaac
Department of Biomedical Informatics, Harvard Medical School, Countway Library, Boston, MA 02215, USA
Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA.
BMJ. 2018 Jan 17;360:j5790. doi: 10.1136/bmj.j5790.
To quantify the effects of varying opioid prescribing patterns after surgery on dependence, overdose, or abuse in an opioid naive population.
Retrospective cohort study.
Surgical claims from a linked medical and pharmacy administrative database of 37 651 619 commercially insured patients between 2008 and 2016.
1 015 116 opioid naive patients undergoing surgery.
Use of oral opioids after discharge as defined by refills and total dosage and duration of use. The primary outcome was a composite of misuse identified by a diagnostic code for opioid dependence, abuse, or overdose.
568 612 (56.0%) patients received postoperative opioids, and a code for abuse was identified for 5906 patients (0.6%, 183 per 100 000 person years). Total duration of opioid use was the strongest predictor of misuse, with each refill and additional week of opioid use associated with an adjusted increase in the rate of misuse of 44.0% (95% confidence interval 40.8% to 47.2%, P<0.001), and 19.9% increase in hazard (18.5% to 21.4%, P<0.001), respectively.
Each refill and week of opioid prescription is associated with a large increase in opioid misuse among opioid naive patients. The data from this study suggest that duration of the prescription rather than dosage is more strongly associated with ultimate misuse in the early postsurgical period. The analysis quantifies the association of prescribing choices on opioid misuse and identifies levers for possible impact.
量化手术后不同阿片类药物处方模式对未使用过阿片类药物人群的药物依赖、过量使用或滥用的影响。
回顾性队列研究。
来自2008年至2016年期间37651619名商业保险患者的医疗和药房行政关联数据库中的手术理赔数据。
1015116名未使用过阿片类药物的手术患者。
出院后口服阿片类药物的使用情况，以再填充情况、总剂量和使用持续时间来定义。主要结局是由阿片类药物依赖、滥用或过量使用的诊断代码确定的误用综合情况。
568612名（56.0%）患者接受了术后阿片类药物治疗，5906名患者（0.6%，每10万人年183例）被确定有滥用代码。阿片类药物使用的总持续时间是误用的最强预测因素，每次再填充以及阿片类药物使用额外一周，分别使误用率调整后增加44.0%（95%置信区间40.8%至47.2%，P<0.001），风险增加19.9%（18.5%至21.4%，P<0.001）。
在未使用过阿片类药物的患者中，每次阿片类药物再填充和使用一周都会使阿片类药物滥用大幅增加。本研究数据表明，在术后早期，处方持续时间而非剂量与最终滥用的关联更强。该分析量化了处方选择与阿片类药物滥用的关联，并确定了可能产生影响的因素。
