Department of Psychiatry, College of Physicians and Surgeons, Columbia University and the New York State Psychiatric Institute, New York, NY, USA.
Department of Psychiatry, College of Physicians and Surgeons, Columbia University and the New York State Psychiatric Institute, New York, NY, USA.
Drug Alcohol Depend. 2018 Sep 1;190:112-119. doi: 10.1016/j.drugalcdep.2018.06.004. Epub 2018 Jul 4.
Little is known about risk factors for repeated opioid overdose and fatal opioid overdose in the first year following nonfatal opioid overdose.
We identified a national retrospective longitudinal cohort of patients aged 18-64 years in the Medicaid program who received a clinical diagnosis of nonfatal opioid overdose. Repeated overdoses and fatal opioid overdoses were measured with the Medicaid record and the National Death Index. Rates of repeat overdose per 1000 person-years and fatal overdose per 100,000 person-years were determined. Hazard ratios of repeated opioid overdose and fatal opioid overdose were estimated by Cox proportional hazards.
Nearly two-thirds (64.8%) of the patients with nonfatal overdoses (total n = 75,556) had filled opioid prescriptions in the 180 days before initial overdose. During the 12 months after nonfatal overdose, the rate of repeat overdose was 295.0 per 1000 person-years and that of fatal opioid overdose was 1154 per 100,000 person-years. After controlling for age, sex, race/ethnicity, and region, the hazard of fatal opioid overdose was increased for patients who had filled a benzodiazepine prescription in the 180 days prior to their initial overdose (HR = 1.71, 95%CI: 1.46-1.99), whose initial overdose involved heroin (HR = 1.57, 95%CI:1.30-1.89), or who required mechanical ventilation at the initial overdose (HR = 1.86, 95%CI = 1.50-2.31).
Adults treated for opioid overdose frequently have repeated opioid overdoses in the following year. They are also at high risk of fatal opioid overdose throughout this period, which underscores the importance of efforts to engage and maintain patients in evidence-based opioid treatments following nonfatal overdose.
在首次非致命性阿片类药物过量后的第一年，对于重复阿片类药物过量和致命性阿片类药物过量的风险因素知之甚少。
我们确定了一项全国性的回顾性纵向队列研究，纳入了医疗补助计划中年龄在 18-64 岁之间、接受过非致命性阿片类药物过量临床诊断的患者。重复过量和致命性阿片类药物过量是通过医疗补助记录和国家死亡索引来测量的。每 1000 人年的重复过量率和每 10 万人年的致命性阿片类药物过量率。通过 Cox 比例风险来估计重复阿片类药物过量和致命性阿片类药物过量的风险比。
近三分之二（64.8%）的非致命性过量患者（总 n=75556）在首次过量前的 180 天内有过阿片类药物处方。在非致命性过量后的 12 个月内，重复过量的发生率为 295.0/1000 人年，致命性阿片类药物过量的发生率为 1154/100000 人年。在控制年龄、性别、种族/民族和地区后，在首次过量前 180 天内开苯二氮䓬类药物处方（HR=1.71，95%CI：1.46-1.99）、初始过量涉及海洛因（HR=1.57，95%CI：1.30-1.89）或在初始过量时需要机械通气（HR=1.86，95%CI：1.50-2.31）的患者，致命性阿片类药物过量的风险增加。
接受阿片类药物过量治疗的成年人在接下来的一年中经常发生重复的阿片类药物过量。在此期间，他们也面临着很高的致命性阿片类药物过量的风险，这突显了在非致命性阿片类药物过量后努力让患者参与并维持接受基于证据的阿片类药物治疗的重要性。
