Kaiser Permanente Northern California, Division of Research, 2000 Broadway, Oakland, CA 94612, United States.
Kaiser Permanente Santa Rosa Medical Center, 3559 Round Barn Blvd, Santa Rosa, CA 95403, United States.
Drug Alcohol Depend. 2020 Apr 1;209:107923. doi: 10.1016/j.drugalcdep.2020.107923. Epub 2020 Feb 20.
A non-fatal opioid overdose (NFOO) increases the risk of another overdose and identifies high-risk patients. We estimated the risk of repeat opioid overdose for patients with and without substance use disorder (SUD) diagnoses and the change in substance use treatment utilization rates associated with the first NFOO.
We selected patients (>18 years of age) from Kaiser Permanente Northern California with a NFOO between 2009-2016 (n = 3,992). Cox proportional hazards models estimated the 1-year risk of opioid overdose associated with SUD diagnoses (opioid, alcohol, cannabis, amphetamine, sedative, and cocaine), controlling for patient characteristics. Among patients with an index NFOO, we calculated monthly utilization rates for outpatient substance use services and buprenorphine before and after the index overdose. Interrupted time series models estimated the change in level and trend in utilization rates associated with the index overdose.
Approximately 7.2 % of patients had a repeat opioid overdose during the year after the index NFOO. The only SUD diagnosis significantly associated with greater risk of repeat overdose was opioid use disorder (OUD) (aHR: 1.51; 95 % CI: 1.13-2.01). Before the index overdose, 4.16 % of patients received outpatient substance use services and 1.32 % received buprenorphine. The index overdose was associated with a 5.94 % (standard error: 0.77 %) absolute increase in outpatient substance use services and a 1.29 % (standard error: 0.15 %) increase in buprenorphine.
Patients with a NFOO and OUD are vulnerable to another overdose. Low initiation rates for substance use treatment after a NFOO indicate a need to address patient, provider, and system barriers.
非致命性阿片类药物过量（NFOO）会增加再次过量的风险，并确定高危患者。我们评估了有无物质使用障碍（SUD）诊断的患者发生重复阿片类药物过量的风险，以及首次 NFOO 后物质使用治疗利用率的变化。
我们从 Kaiser Permanente Northern California 中选择了 2009 年至 2016 年间发生 NFOO 的年龄>18 岁的患者（n=3992）。Cox 比例风险模型估计了 SUD 诊断（阿片类、酒精、大麻、安非他命、镇静剂和可卡因）与阿片类药物过量相关的 1 年风险，同时控制了患者特征。在有指数 NFOO 的患者中，我们计算了指数 NFOO 前后门诊物质使用服务和丁丙诺啡的每月利用率。中断时间序列模型估计了与指数 NFOO 相关的利用率水平和趋势的变化。
大约 7.2%的患者在发生指数 NFOO 后的一年内再次发生阿片类药物过量。唯一与重复过量风险增加相关的 SUD 诊断是阿片类药物使用障碍（OUD）（aHR：1.51；95%CI：1.13-2.01）。在指数 NFOO 之前，4.16%的患者接受门诊物质使用服务，1.32%的患者接受丁丙诺啡。指数 NFOO 与门诊物质使用服务绝对增加 5.94%（标准误差：0.77%）和丁丙诺啡增加 1.29%（标准误差：0.15%）相关。
发生 NFOO 和 OUD 的患者易发生再次过量。NFOO 后物质使用治疗的起始率较低表明需要解决患者、提供者和系统障碍。
