Institute for Work and Health, Toronto, Ontario, Canada
Institute for Work and Health, Toronto, Ontario, Canada.
Occup Environ Med. 2020 Sep;77(9):637-647. doi: 10.1136/oemed-2019-106380. Epub 2020 Jul 7.
The objective of this historical cohort study was to determine the claimant and prescriber factors associated with receiving opioids at first postinjury dispense compared with non-steroidal anti-inflammatory drugs (NSAIDs) and skeletal muscle relaxants (SMRs) in a sample of workers' compensation claimants with low back pain (LBP) claims between 1998 and 2009 in British Columbia, Canada.
Administrative workers' compensation, prescription and healthcare data were linked. The association between claimant factors (sociodemographics, occupation, diagnosis, comorbidities, pre-injury prescriptions and healthcare) and prescriber factors (sex, birth year, specialty) with drug class(es) at first dispense (opioids vs NSAIDs/SMRs) was examined with multilevel multinomial logistic regression.
Increasing days supplied with opioids in the previous year was associated with increased odds of receiving opioids only (1-14 days OR 1.62, 95% CI 1.51 to 1.75; ≥15 days OR 5.12, 95% CI 4.65 to 5.64) and opioids with NSAIDs/SMRs (1-14 days OR 1.49, 95% CI 1.39 to 1.60; ≥15 days OR 2.82, 95% CI 2.56 to 3.12). Other significant claimant factors included: pre-injury dispenses for NSAIDs, SMRs, antidepressants, anticonvulsants and sedative-hypnotics/anxiolytics; International Statistical Classification of Diseases and Related Health Problems, 9th Revision diagnosis; various pre-existing comorbidities; prior physician visits and hospitalisations; and year of injury, age, sex, health authority and occupation. Prescribers accounted for 25%-36% of the variability in the drug class(es) received, but prescriber sex, specialty and birth year did not explain observed between-prescriber variation.
During this period in the opioid crisis, early postinjury dispensing was multifactorial, with several claimant factors associated with receiving opioids at first prescription. Prescriber variation in drug class choice appears particularly important, but was not explained by basic prescriber characteristics.
本历史队列研究的目的是确定在不列颠哥伦比亚省 1998 年至 2009 年间患有下腰痛（LBP）的工人赔偿索赔者中，与非甾体抗炎药（NSAIDs）和骨骼肌松弛剂（SMRs）相比，首次受伤后配药时接受阿片类药物的索赔者和处方者因素。
将行政工人赔偿、处方和医疗保健数据联系起来。使用多层次多项逻辑回归检查索赔者因素（社会人口统计学、职业、诊断、合并症、受伤前的处方和医疗保健）与处方者因素（性别、出生年份、专业）与首次配药时药物类别（阿片类药物与 NSAIDs/SMRs）之间的关联。
在前一年供应的阿片类药物天数增加与仅接受阿片类药物的几率增加相关（1-14 天 OR 1.62，95%CI 1.51-1.75；≥15 天 OR 5.12，95%CI 4.65-5.64）和阿片类药物与 NSAIDs/SMRs（1-14 天 OR 1.49，95%CI 1.39-1.60；≥15 天 OR 2.82，95%CI 2.56-3.12）。其他重要的索赔者因素包括：受伤前的 NSAIDs、SMRs、抗抑郁药、抗惊厥药和镇静催眠药/抗焦虑药的配药；国际疾病分类和相关健康问题，第 9 版诊断；各种预先存在的合并症；先前的医生就诊和住院治疗；以及受伤年份、年龄、性别、卫生当局和职业。开处方者占所接受药物类别的 25%-36%，但开处方者的性别、专业和出生年份并不能解释观察到的处方者之间的差异。
在阿片类药物危机期间，受伤后早期配药是多因素的，有几个索赔者因素与首次处方时接受阿片类药物有关。药物类别的选择方面的处方者差异似乎尤为重要，但不能用基本的处方者特征来解释。
