Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan; Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan.
Michigan Opioid Prescribing Engagement Network, Ann Arbor, Michigan.
Am J Prev Med. 2021 Aug;61(2):165-173. doi: 10.1016/j.amepre.2021.02.008. Epub 2021 Apr 29.
It is unknown whether dental opioid prescriptions are associated with opioid overdose in patients or their family members, who may have access to patients' opioids.
During July-October 2020, the 2011-2018 IBM MarketScan Dental, IBM MarketScan Commercial, and Medicaid Multi-State Databases were analyzed. Two analyses were conducted. In the patient analysis, dental procedures for privately and publicly insured patients aged 13-64 years were identified. The exposure was ≥1 initial prescription (dispensed opioid prescription within 3 days of the procedure). The association between the exposure and ≥1 overdose within 90 days of the procedure was evaluated using logistic regression. In the family analysis, procedures for privately insured patients in family plans were identified. The association between the exposure and ≥1 overdose in a family member within 90 days was evaluated using logistic regression. In both analyses, the average marginal effect of the exposure was calculated, representing the change in the probability of the outcome if all versus if no procedures were associated with ≥1 initial prescription.
The patient analysis included 8,544,098 procedures. When ≥1 initial prescription did and did not occur, the 90-day risk of overdose was 5.8 versus 2.2 per 10,000 procedures (average marginal effect=1.5, 95% CI=1.2, 1.8). The family analysis included 3,461,469 procedures. When ≥1 initial prescription did and did not occur, the 90-day risk of overdose in a family member was 1.7 versus 1.0 per 10,000 procedures (average marginal effect=0.4, 95% CI=0.1, 0.7).
Findings further highlight the importance of avoiding unnecessary dental opioid prescribing.
目前尚不清楚牙科阿片类药物处方是否与患者或其家属（可能接触到患者的阿片类药物）的阿片类药物过量有关。
在 2020 年 7 月至 10 月期间，分析了 2011-2018 年 IBM MarketScan 牙科、IBM MarketScan 商业和 Medicaid 多州数据库。进行了两项分析。在患者分析中，确定了 13-64 岁私人和公共保险患者的牙科程序。暴露是指≥1 次初始处方（程序后 3 天内配药的阿片类药物处方）。使用逻辑回归评估暴露与程序后 90 天内≥1 次过量的关联。在家庭分析中，确定了家庭计划中私人保险患者的程序。使用逻辑回归评估暴露与家庭中≥1 名家庭成员在 90 天内的≥1 次过量之间的关联。在这两项分析中，计算了暴露的平均边际效应，代表如果所有程序都与≥1 次初始处方相关，那么结果发生的概率变化。
患者分析包括 8544088 例程序。当≥1 次初始处方发生和未发生时，90 天内的过量风险分别为每 10000 例 5.8 例和 2.2 例（平均边际效应=1.5，95%置信区间=1.2，1.8）。家庭分析包括 3461469 例程序。当≥1 次初始处方发生和未发生时，90 天内家庭成员的过量风险分别为每 10000 例 1.7 例和 1.0 例（平均边际效应=0.4，95%置信区间=0.1，0.7）。
研究结果进一步强调了避免不必要的牙科阿片类药物处方的重要性。
