Delorme Jessica, Chenaf Chouki, Bertin Celian, Riquelme Marie, Eschalier Alain, Ardid Denis, Authier Nicolas
Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Clermont-Ferrand, France.
Observatoire Français des Médicaments Antalgiques/French Monitoring Centre for Analgesic Drugs, Université Clermont Auvergne - CHU Clermont-Ferrand, Clermont-Ferrand, France.
Front Psychiatry. 2018 Jul 23;9:335. doi: 10.3389/fpsyt.2018.00335. eCollection 2018.
Treating pain and opioid use disorder represents a clinical challenge. While most studies that have assessed opioid analgesic use in opioid substitution treatment (OST) patients primarily address opioid analgesic misuse (1, 2), only few studies focused on OST patients assessed the prescription of analgesic opioids for chronic pain. We sought to compare the prevalence of analgesic opioid prescription (AOP) in two groups of chronic non-cancer pain (CNCP) patients: OST patients vs. the general population. This was a population-based cross-sectional study based on the French national healthcare claims database SNIIRAM (Système National d'Informations Inter-Régimes de l'Assurance Maladie) covering over 66 million people (98.8% of the French population). Overall, 67,173 participants ≥15 years old undergoing continuous OST in 2015 ("OST patients" group) were included and age- and gender-matched by means of a 1:1 ratio with 67,173 patients without OST ("control" group). In each group, patients with cancer conditions were excluded and those having received opioid and non-opioid analgesics for at least 3 months were identified (CNCP patients). Compared to control patients, CNCP OST patients received less AOP (47.8 vs. 68.0%, < 0.0001) and more often non-opioid prescription (52.2 vs. 32.0%, < 0.0001). In multivariate analysis, CNCP OST patients were 2.7 times less likely to be prescribed analgesic opioids (adjusted odds ratio [OR] = 2.7 [2.42-3.01], < 0.0001) than control patients. AOP correlated in CNCP OST patients with: age ≤ 40 years old, female gender, low-income status, methadone-maintained treatment, mental health disorder, hepatitis C virus (HCV) infection, and alcohol abuse disorder. Opioid analgesics were less often prescribed in CNCP OST patients. AOP prevalence was 2.7-fold lower than in the general population. Chronic pain management in OST patients needs to be reinforced through additional physician training and a multidisciplinary approach.
治疗疼痛和阿片类药物使用障碍是一项临床挑战。虽然大多数评估阿片类药物替代治疗（OST）患者使用阿片类镇痛药的研究主要关注阿片类镇痛药的滥用情况（1,2），但仅有少数针对OST患者的研究关注慢性疼痛的阿片类镇痛药处方。我们试图比较两组慢性非癌性疼痛（CNCP）患者中阿片类镇痛药处方（AOP）的患病率：OST患者与普通人群。这是一项基于法国国家医疗保健索赔数据库SNIIRAM（国家疾病保险跨制度信息系统）的基于人群的横断面研究，该数据库覆盖超过6600万人（占法国人口的98.8%）。总体而言，纳入了2015年接受持续OST的67173名年龄≥15岁的参与者（“OST患者”组），并通过1:1的比例与67173名未接受OST的患者（“对照组”）进行年龄和性别匹配。在每组中，排除患有癌症的患者，并确定那些接受阿片类和非阿片类镇痛药至少3个月的患者（CNCP患者）。与对照患者相比，CNCP OST患者接受AOP的比例较低（47.8%对68.0%，<0.0001），且更常接受非阿片类药物处方（52.2%对32.0%，<0.0001）。在多变量分析中，CNCP OST患者被开具阿片类镇痛药的可能性比对照患者低2.7倍（调整后的优势比[OR]=2.7[2.42 - 3.01]，<0.0001）。在CNCP OST患者中，AOP与以下因素相关：年龄≤40岁、女性、低收入状态、美沙酮维持治疗、精神健康障碍、丙型肝炎病毒（HCV）感染和酒精滥用障碍。CNCP OST患者较少被开具阿片类镇痛药。AOP患病率比普通人群低2.7倍。需要通过额外的医生培训和多学科方法加强OST患者的慢性疼痛管理。
