Justice Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia.
Justice Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia; Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, VIC, Australia; Mater Research Institute-UQ, University of Queensland, Brisbane, QLD, Australia; Griffith Criminology Institute, Griffith University, Brisbane, QLD, Australia.
Lancet Public Health. 2021 Apr;6(4):e249-e259. doi: 10.1016/S2468-2667(21)00007-4.
Being recently released from prison or discharged from hospital, or being dispensed opioids, benzodiazepines, or antipsychotics have been associated with an increased risk of fatal drug overdose. This study aimed to examine the association between these periods and non-fatal drug overdose using a within-person design.
In this self-controlled case series, we used data from the provincial health insurance client roster to identify a 20% random sample of residents (aged ≥10 years) in British Columbia, Canada between Jan 1, 2015, and Dec 31, 2017 (n=921 346). Individuals aged younger than 10 years as of Jan 1, 2015, or who did not have their sex recorded in the client roster were excluded. We used linked provincial health and correctional records to identify a cohort of individuals who had a non-fatal overdose resulting in medical care during this time period, and key exposures, including periods of incarceration, admission to hospital, emergency department care, and supply of medications for opioid use disorder (MOUD), opioids for pain (unrelated to MOUD), benzodiazepines, and antipsychotics. Using a self-controlled case series, we examined the association between the time periods during and after each of these exposures and the incidence of non-fatal overdose with case-only, conditional Poisson regression analysis. Sensitivity analyses included recurrent overdoses and pre-exposure risk periods.
We identified 4149 individuals who had a non-fatal overdose in 2015-17. Compared with unexposed periods (ie, all follow-up time that was not part of a designated risk period for each exposure), the incidence of non-fatal overdose was higher on the day of admission to prison (adjusted incidence rate ratio [aIRR] 2·76 [95% CI 1·51-5·04]), at 1-2 weeks (2·92 [2·37-3·61]), and 3-4 weeks (1·34 [1·01-1·78]) after release from prison, 1-2 weeks after discharge from hospital (1·35 [1·11-1·63]), when being dispensed opioids for pain (after ≥4 weeks) or benzodiazepines (entire use period), and from 3 weeks after discontinuing antipsychotics. The incidence of non-fatal overdose was reduced during use of MOUD (aIRRs ranging from 0·33 [0·26-0·42] to 0·41 [0·25-0·67]) and when in prison (0·12 [0·08-0·19]).
Expanding access to and increasing support for stable and long-term medication for the management of opioid use disorder, improving continuity of care when transitioning between service systems, and ensuring safe prescribing and medication monitoring processes for medications that reduce respiratory function (eg, benzodiazepines) could decrease the incidence of non-fatal overdose.
Murdoch Children's Research Institute and National Health and Medical Research Council.
最近刚出狱或出院，或正在开处阿片类药物、苯二氮䓬类药物或抗精神病药物，这些都与致命药物过量的风险增加有关。本研究旨在使用个体内设计来检查这些时期与非致命药物过量之间的关联。
在这项自我对照病例系列研究中，我们使用来自省级健康保险客户名单的数据，确定了 2015 年 1 月 1 日至 2017 年 12 月 31 日期间加拿大不列颠哥伦比亚省≥10 岁的居民（n=921346）的 20%随机样本。2015 年 1 月 1 日前年龄小于 10 岁或客户名单中未记录其性别的个人被排除在外。我们使用链接的省级健康和惩教记录来确定在此期间因医疗护理而导致非致命过量的个体队列，以及关键暴露，包括监禁期、住院、急诊护理和提供用于治疗阿片类药物使用障碍的药物（MOUD）、治疗疼痛的阿片类药物（与 MOUD 无关）、苯二氮䓬类药物和抗精神病药物。使用自我对照病例系列，我们使用病例仅有的条件泊松回归分析，检查了每次暴露期间和之后的时间段与非致命性过量的发生率之间的关联。敏感性分析包括复发性过量和暴露前风险期。
我们确定了 2015-17 年间有 4149 人发生非致命性过量。与未暴露期（即每个暴露的所有随访时间都不属于指定风险期）相比，入狱当天（校正发病率比 [aIRR] 2·76 [95%CI 1·51-5·04]）、1-2 周（2·92 [2·37-3·61]）和 3-4 周（1·34 [1·01-1·78]）后的药物过量发生率更高，出院后 1-2 周（1·35 [1·11-1·63]），当开出用于治疗疼痛的阿片类药物（≥4 周后）或苯二氮䓬类药物（整个使用期）时，以及停用抗精神病药物后 3 周。使用 MOUD 时（aIRRs 范围为 0·33 [0·26-0·42]至 0·41 [0·25-0·67]）和入狱时（0·12 [0·08-0·19]）药物过量的发生率降低。
扩大获得和支持稳定和长期药物治疗管理阿片类药物使用障碍的机会，改善服务系统之间的护理连续性，并确保减少呼吸功能的药物（如苯二氮䓬类药物）的安全处方和药物监测过程，可能会降低非致命性药物过量的发生率。
默多克儿童研究所和澳大利亚国家卫生与医学研究理事会。
