Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, IN, United States.
Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, United States.
Pain. 2019 Nov;160(11):2464-2472. doi: 10.1097/j.pain.0000000000001643.
There is evidence of greater opioid prescription to individuals in the United States with mental health conditions. Whether these associations generalize beyond the US prescription environment and to familial mental health and socioeconomic status (SES) has not been examined comprehensively. This study estimated associations of diverse preexisting mental health diagnoses, parental mental health history, and SES in childhood with opioid analgesic prescription patterns nationwide in Sweden. Using register-based data, we identified 5,071,193 (48.4% female) adolescents and adults who were naive to prescription opioid analgesics and followed them from 2007 to 2014. The cumulative incidence of any dispensed opioid analgesic within 3 years was 11.4% (95% CI, 11.3%-11.4%). Individuals with preexisting self-injurious behavior, as well as opioid and other substance use, attention-deficit/hyperactivity, depressive, anxiety, and bipolar disorders had greater opioid therapy initiation rates than did individuals without the respective conditions (hazard ratios from 1.24 [1.20-1.27] for bipolar disorder to 2.12 [2.04-2.21] for opioid use disorder). Among 1,298,083 opioid recipients, the cumulative incidence of long-term opioid therapy (LTOT) was 7.6% (7.6%-7.7%) within 3 years of initiation. All mental health conditions were associated with greater LTOT rates (hazard ratios from 1.66 [1.56-1.77] for bipolar disorder to 3.82 [3.51-4.15] for opioid use disorder) and were similarly associated with concurrent benzodiazepine-opioid therapy. Among 1,482,462 adolescents and young adults, initiation and LTOT rates were greater for those with parental mental health history or lower childhood SES. Efforts to understand and ameliorate potential adverse effects of opioid analgesics must account for these patterns.
美国有精神健康问题的人群开具阿片类药物的处方数量更多。这些关联是否超出了美国的处方环境，以及是否与家庭精神健康和社会经济地位（SES）有关，尚未得到全面研究。本研究使用瑞典全国范围内的登记数据，评估了各种先前存在的精神健康诊断、父母的精神健康史以及儿童时期 SES 与阿片类镇痛药处方模式的关联。我们确定了 5071193 名（48.4%为女性）对处方阿片类镇痛药无用药史的青少年和成年人，并对其进行了从 2007 年至 2014 年的随访。3 年内任何一种阿片类镇痛药的累积发病率为 11.4%（95%CI，11.3%-11.4%）。有自残行为以及阿片类药物和其他物质使用障碍、注意缺陷多动障碍、抑郁、焦虑和双相情感障碍的个体比没有相应疾病的个体更有可能开始接受阿片类药物治疗（危险比为 1.24 [1.20-1.27] 至 2.12 [2.04-2.21] ，分别为双相情感障碍和阿片类药物使用障碍）。在 1298083 名阿片类药物使用者中，3 年内 LTOT 的累积发生率为 7.6%（7.6%-7.7%）。所有精神健康状况均与更高的 LTOT 发生率相关（危险比为 1.66 [1.56-1.77] 至 3.82 [3.51-4.15] ，分别为双相情感障碍和阿片类药物使用障碍），并且与同时使用苯二氮䓬类药物-阿片类药物治疗相关。在 1482462 名青少年和年轻人中，有父母精神健康史或较低儿童 SES 的个体，开始使用和 LTOT 的比率更高。为了理解和减轻阿片类镇痛药的潜在不良影响，必须考虑到这些模式。
