阿片类药物使用障碍治疗与酒精相关的急性事件的关联。

Association of Opioid Use Disorder Treatment With Alcohol-Related Acute Events.

机构信息

Health and Behavior Research Center, Department of Psychiatry, Washington University School of Medicine in St Louis, St Louis, Missouri.

Now with Center for Technology and Behavioral Health, Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.

出版信息

JAMA Netw Open. 2021 Feb 1;4(2):e210061. doi: 10.1001/jamanetworkopen.2021.0061.

DOI:10.1001/jamanetworkopen.2021.0061

PMID:33625511

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7905500/

Abstract

IMPORTANCE

Persons with opioid use disorder (OUD) and co-occurring alcohol use disorder (AUD) are understudied and undertreated. It is unknown whether the use of medications to treat OUD is associated with reduced risk of alcohol-related morbidity.

OBJECTIVE

To determine whether the use of OUD medications is associated with decreased risk for alcohol-related falls, injuries, and poisonings in persons with OUD with and without co-occurring AUD.

DESIGN, SETTING, AND PARTICIPANTS: This recurrent-event, case-control, cohort study used prescription claims from IBM MarketScan insurance databases from January 1, 2006, to December 31, 2016. The sample included persons aged 12 to 64 years in the US with an OUD diagnosis and taking OUD medication who had at least 1 alcohol-related admission. The unit of observation was person-day. Data analysis was performed from June 26 through September 28, 2020.

EXPOSURES

Days of active OUD medication prescriptions, with either agonist (ie, buprenorphine or methadone) or antagonist (ie, oral or extended-release naltrexone) treatments compared with days without OUD prescriptions.

MAIN OUTCOMES AND MEASURES

The primary outcome was admission for any acute alcohol-related event defined by International Classification of Diseases, Ninth Revision and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes. Conditional logistic regression was used to compare OUD medication use between days with and without an alcohol-related event. Stratified analyses were conducted between patients with OUD with and without a recent AUD diagnostic code.

RESULTS

There were 8 424 214 person-days of observation time among 13 335 participants who received OUD medications and experienced an alcohol-related admission (mean [SD] age, 33.1 [13.1] years; 5884 female participants [44.1%]). Agonist treatments (buprenorphine and methadone) were associated with reductions in the odds of any alcohol-related acute event compared with nontreatment days, with a 43% reduction for buprenorphine (odds ratio [OR], 0.57; 95% CI, 0.52-0.61) and a 66% reduction for methadone (OR, 0.34; 95% CI, 0.26-0.45). The antagonist treatment naltrexone was associated with reductions in alcohol-related acute events compared with nonmedication days, with a 37% reduction for extended-release naltrexone (OR, 0.63; 95% CI, 0.52-0.76) and a 16% reduction for oral naltrexone (OR, 0.84; 95% CI, 0.76-0.93). Naltrexone use was more prevalent among patients with OUD with recent AUD claims than their peers without AUD claims.

CONCLUSIONS AND RELEVANCE

These findings suggest that OUD medication is associated with fewer admissions for alcohol-related acute events in patients with OUD with co-occurring AUD.

摘要

重要性

患有阿片类药物使用障碍（OUD）和共病酒精使用障碍（AUD）的患者研究不足且治疗不足。目前尚不清楚治疗 OUD 的药物是否与降低酒精相关发病率有关。

目的

确定 OUD 药物的使用是否与 OUD 患者（伴或不伴共病 AUD）的酒精相关跌倒、伤害和中毒风险降低有关。

设计、设置和参与者：本研究采用 IBM MarketScan 保险数据库的回顾性事件、病例对照、队列研究，时间为 2006 年 1 月 1 日至 2016 年 12 月 31 日。样本包括年龄在 12 至 64 岁之间、有 OUD 诊断且服用 OUD 药物的美国患者，这些患者至少有 1 次酒精相关住院。观察单位为人天。数据分析于 2020 年 6 月 26 日至 9 月 28 日进行。

暴露情况

与没有 OUD 处方相比，有阿片类药物活性处方（即丁丙诺啡或美沙酮）或拮抗剂（即口服或延长释放型纳曲酮）治疗的天数。

主要结果和措施

主要结局是通过国际疾病分类、第九版和国际疾病与相关健康问题统计分类、第十版代码定义的任何急性酒精相关事件的入院情况。使用条件逻辑回归比较有和没有酒精相关事件的日子里 OUD 药物的使用情况。对伴有和不伴有近期 AUD 诊断的 OUD 患者进行分层分析。

结果

在接受 OUD 药物治疗且发生酒精相关入院的 13335 名患者中，有 8424214 人天的观察时间（平均[SD]年龄，33.1[13.1]岁；5884 名女性参与者[44.1%]）。与非治疗日相比，阿片类激动剂（丁丙诺啡和美沙酮）治疗与任何酒精相关急性事件的几率降低有关，丁丙诺啡降低 43%（比值比[OR]，0.57；95% CI，0.52-0.61），美沙酮降低 66%（OR，0.34；95% CI，0.26-0.45）。拮抗剂纳曲酮与酒精相关急性事件的发生率降低有关，与非药物治疗日相比，延长释放型纳曲酮降低 37%（OR，0.63；95% CI，0.52-0.76），口服纳曲酮降低 16%（OR，0.84；95% CI，0.76-0.93）。有 OUD 且近期有 AUD 就诊史的患者中，纳曲酮的使用比无 AUD 就诊史的患者更为普遍。