Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada.
Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada.
Pain. 2021 Mar 1;162(3):740-748. doi: 10.1097/j.pain.0000000000002075.
Low back pain is a leading cause of disability globally. It is a common reason for presentation to the emergency department where opioids are commonly prescribed. This is a retrospective cohort study of opioid-naive adults with low back pain presenting to 1 of 4 emergency departments in Nova Scotia. We use routinely collected administrative clinical and drug-use data (July 2010-November 2017) to investigate the prevalence of prolonged opioid use and associated individual and prescription characteristics. In total, 23,559 eligible individuals presented with nonspecific low back pain, with 84.4% being opioid-naive. Our study population included 4023 opioid-naive individuals who filled a new opioid prescription within 7 days after their index emergency department visit (24.4%). The prevalence of prolonged opioid use after a new opioid prescription for low back pain (filling an opioid prescription 8-90 days after the emergency department visit and filling a subsequent prescription ±30 days of 6 months) was 4.6% (185 individuals). Older age and female sex were associated with clinically important increased odds of prolonged opioid use. First prescription average >90 morphine milligram equivalents/day (odds ratio 1.6, 95% confidence interval 1.0-2.6) and greater than 7-day supply (1.9, 1.1-3.1) were associated with prolonged opioid use in adjusted models. We found evidence of declining opioid prescriptions over the study period, but that 24.3% of first opioid prescriptions in 2016 would not have aligned with current guideline recommendations. Our study provides evidence to support a cautious approach to prescribing in opioid-naive populations.
腰痛是全球导致残疾的主要原因。它是急诊就诊的常见原因，常开具阿片类药物。这是一项回顾性队列研究，纳入了在新斯科舍省的 4 家急诊就诊的阿片类药物初治腰痛的成年人。我们使用常规收集的行政临床和药物使用数据（2010 年 7 月至 2017 年 11 月），调查长期使用阿片类药物的流行率及其个体和处方特征。共有 23559 名符合条件的个体因非特异性腰痛就诊，其中 84.4%为阿片类药物初治者。我们的研究人群包括 4023 名阿片类药物初治者，他们在急诊科就诊后 7 天内开出了新的阿片类药物处方（24.4%）。在新开出阿片类药物处方后（在急诊科就诊后 8-90 天开出阿片类药物处方，随后在 6 个月内 ±30 天开出后续处方），长期使用阿片类药物的流行率为 4.6%（185 人）。年龄较大和女性与长期使用阿片类药物的可能性显著增加相关。首次处方平均吗啡用量 >90 毫克当量/天（比值比 1.6，95%置信区间 1.0-2.6）和超过 7 天供应量（1.9，1.1-3.1）与调整模型中的长期阿片类药物使用相关。我们发现研究期间阿片类药物处方呈下降趋势，但 2016 年首次开出的 24.3%阿片类药物处方不符合当前指南建议。我们的研究提供了证据，支持在阿片类药物初治人群中谨慎处方。
