急诊科阿片类药物给药与持续阿片类药物使用的关联：一项背痛患者的回顾性队列研究。
Association of Emergency Department Opioid Administration With Ongoing Opioid Use: A Retrospective Cohort Study of Patients With Back Pain.
机构信息
From the, Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
and the, Center for Innovative Design and Analysis, School of Public Health, University of Colorado, Aurora, CO, USA.
出版信息
Acad Emerg Med. 2020 Nov;27(11):1158-1165. doi: 10.1111/acem.14071. Epub 2020 Jul 30.
OBJECTIVES
Opioids are commonly administered in the emergency department (ED) and prescribed for the treatment of back pain. It is important to understand the unintended consequences of this approach to inform treatment decisions and the consideration of alternative treatments. Recent evidence has shown that ED opioid prescriptions are associated with future opioid use. The objective of this study was to measure the association of opioid administration in the ED to patients treated for back pain with future opioid use.
METHODS
This is a retrospective study of opioid-naïve adults discharged from the ED with a diagnosis of back pain. Patients were stratified by opioid therapy (none, ED administration only, prescription only, or ED administration + prescription). Relative risks of ongoing opioid use (filling >90-day supply in 180 days following ED visit as documented in the prescription drug monitoring program) were calculated for each opioid-therapy group and compared to the no-opioid group.
RESULTS
We identified 24,487 opioid naïve back pain patients. The median age was 38 years, 55% were female, and 56% were non-Hispanic white. A total of 41% received no opioid, 10% were only administered an opioid in the ED, 18% only received a prescription, and 31% received an opioid in the ED + prescription. The adjusted relative risks of ongoing use compared to the no opioid group were as follows: ED only 1.9, prescription only 2.1, and ED + prescription 2.3. The increased risk persisted for other definitions of ongoing use and after adjustment for baseline pain scores.
CONCLUSIONS
For opioid-naïve patients with back pain, both administration of an opioid in the ED and opioid prescriptions are associated with a doubling of the risk of ongoing opioid use compared to patients not treated with opioids. This supports the consideration of minimizing exposure to opioids while treating back pain in the ED.
目的
阿片类药物在急诊科（ED）中经常使用，并用于治疗背痛。了解这种方法的意外后果对于告知治疗决策和考虑替代治疗方法非常重要。最近的证据表明，ED 阿片类药物处方与未来的阿片类药物使用有关。本研究的目的是测量 ED 中阿片类药物的使用与接受背痛治疗的患者未来阿片类药物使用之间的关联。
方法
这是一项对从 ED 出院的阿片类药物初治背痛患者进行的回顾性研究。患者按阿片类药物治疗（无、仅 ED 给药、仅处方、ED 给药+处方）分层。根据处方药物监测计划记录的 180 天内 90 天以上的持续阿片类药物使用（填充），计算每个阿片类药物治疗组的持续阿片类药物使用的相对风险，并与无阿片类药物组进行比较。
结果
我们确定了 24487 名阿片类药物初治背痛患者。中位年龄为 38 岁，55%为女性，56%为非西班牙裔白人。共有 41%的患者未接受阿片类药物治疗，10%的患者仅在 ED 接受阿片类药物治疗，18%的患者仅接受处方，31%的患者在 ED 接受阿片类药物治疗+处方。与未接受阿片类药物治疗的患者相比，持续使用的调整后相对风险如下：仅 ED 1.9，仅处方 2.1，ED+处方 2.3。对于其他持续使用的定义和调整基线疼痛评分后，风险仍然存在。
结论
对于阿片类药物初治的背痛患者，ED 中给予阿片类药物和阿片类药物处方都与与未接受阿片类药物治疗的患者相比，持续使用阿片类药物的风险增加一倍有关。这支持在 ED 治疗背痛时考虑尽量减少阿片类药物暴露。
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