Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Quebec, Canada
McGill Clinical and Health Informatics, McGill University, Montréal, Quebec, Canada.
BMJ Open. 2021 Feb 18;11(2):e042299. doi: 10.1136/bmjopen-2020-042299.
Opioid overdoses have increased substantially over the last 20 years, with over 400 000 deaths in North America. While opioid prescribing has been a target of research, benzodiazepine and opioid co-intoxication has emerged as a potential risk factor. Our aim was to assess the risk of opioid overdose associated with concurrent use of opioids and benzodiazepines relative to opioids alone.
A retrospective cohort study will be conducted using medical claims data from adult residents of Montréal, Canada. We will create a cohort of new users of opioids (ie, no opioid dispensations in prior year) in 2000-2014 from people with at least 2 years of continuous health insurance. Those with any diagnosis or hospitalisation for cancer or palliative care in the 2 years before their first opioid dispensation will be excluded. On each person-day of follow-up, exposure status will be classified into one of four mutually exclusive categories: (1) opioid-only, (2) benzodiazepine-only, (3) both opioid and benzodiazepine (concurrent use) or (4) neither. Opioid overdose will be measured using diagnostic codes documented in the hospital discharge abstract database, physician billing claims from emergency department visits and death records. Using a marginal structural Cox proportional hazards model, we will compare the hazard of overdose during intervals of concurrent opioid and benzodiazepine use to intervals of opioid use alone, adjusted for sociodemographics, medical and psychiatric comorbidities, and substance use disorders.
This study is approved by the McGill Faculty of Medicine Institutional Review Board and the (Québec privacy commission). Results will be relevant to clinicians, policymakers and other researchers interested in co-prescribing practices of opioids and benzodiazepines. Study findings will be disseminated at relevant conferences and published in biomedical and epidemiological peer-reviewed journals.
在过去的 20 年里，阿片类药物过量的情况大幅增加，在北美已有超过 40 万人因此死亡。虽然阿片类药物的处方一直是研究的目标，但苯二氮䓬类药物和阿片类药物同时中毒已成为一个潜在的风险因素。我们的目的是评估同时使用阿片类药物和苯二氮䓬类药物相对于单独使用阿片类药物与阿片类药物过量的相关性。
我们将使用来自加拿大蒙特利尔成年居民的医疗索赔数据进行回顾性队列研究。我们将从至少连续 2 年有健康保险的人群中，创建一个 2000-2014 年新使用阿片类药物（即前一年没有阿片类药物配药）的队列。在首次阿片类药物配药前的 2 年内，有任何癌症或姑息治疗诊断或住院治疗的人将被排除在外。在每个随访人日，暴露状态将分为以下四种互斥类别之一：（1）仅阿片类药物，（2）仅苯二氮䓬类药物，（3）同时使用阿片类药物和苯二氮䓬类药物（同时使用）或（4）两者都没有。阿片类药物过量将使用医院出院摘要数据库中记录的诊断代码、急诊科就诊的医生计费索赔和死亡记录来测量。使用边缘结构 Cox 比例风险模型，我们将比较同时使用阿片类药物和苯二氮䓬类药物与单独使用阿片类药物期间的过量风险，调整因素包括社会人口统计学、医疗和精神共病以及物质使用障碍。
这项研究得到了麦吉尔医学院机构审查委员会和（魁北克隐私委员会）的批准。研究结果将与对阿片类药物和苯二氮䓬类药物同时处方实践感兴趣的临床医生、政策制定者和其他研究人员相关。研究结果将在相关会议上公布，并发表在生物医学和流行病学同行评议期刊上。
