From the School of Pharmacy, Sungkyunkwan University, Suwon, South Korea.
J Psychoactive Drugs. 2021 Jul-Aug;53(3):224-229. doi: 10.1080/02791072.2020.1856456. Epub 2020 Dec 9.
Long-term use of opioid analgesics can lead to addiction and opioid-related death. We aimed to present the pattern of long-term opioid utilization and identify factors associated with it by using group-based trajectory modeling. We used the nationwide health insurance claims database from 2009 to 2013. Multinomial logistic regression was conducted to estimate the adjusted odds ratio (aOR) and its 95% confidence intervals (CI) for the risk of sustained opioid use associated with various clinical factors. Among 15,327 patients prescribed with opioids, three trajectories were identified: high-sustained users (4.6%, n = 713), early discontinuation (84.2%, n = 12,916), and slow discontinuation (11.2%, n = 1,698). A higher proportion of women (72.8% vs. 58.4%) and elderly patients (55.9% vs. 22.1%) were found in the high-sustained users than the early discontinuation group. Depression (aOR 3.55, 95% CI 1.99-6.35) and epilepsy (aOR 10.12, CI 4.72-21.67) were the two highest comorbidities associated with sustained opioid use in the high-sustained users when compared to the early discontinuation group. Among chronic non-cancer patients, 4.6% were prescribed opioids consistently. Both healthcare providers and patients should be aware of the factors associated with sustained opioid use when prescribing it to patients with mental-related conditions, and its consequent adverse events should be carefully monitored.
长期使用阿片类镇痛药可导致成瘾和与阿片类药物相关的死亡。本研究旨在采用基于群组的轨迹建模方法，展示长期阿片类药物使用模式，并确定与之相关的因素。我们使用了 2009 年至 2013 年全国健康保险索赔数据库。采用多变量逻辑回归分析，估计与各种临床因素相关的持续性阿片类药物使用风险的调整比值比（aOR）及其 95%置信区间（CI）。在 15327 例接受阿片类药物治疗的患者中，确定了 3 种轨迹：高持续使用者（4.6%，n=713）、早期停药者（84.2%，n=12916）和缓慢停药者（11.2%，n=1698）。与早期停药组相比，高持续使用者中女性（72.8% vs. 58.4%）和老年患者（55.9% vs. 22.1%）比例较高。与早期停药组相比，抑郁症（aOR 3.55，95%CI 1.99-6.35）和癫痫（aOR 10.12，CI 4.72-21.67）是高持续使用者中与持续性阿片类药物使用相关的两个最高合并症。在慢性非癌症患者中，4.6%的患者持续开具阿片类药物。当为患有精神相关疾病的患者开具阿片类药物时，医疗保健提供者和患者都应注意与持续性阿片类药物使用相关的因素，并应仔细监测其相关的不良事件。
