Salas Joanne, Li Xue, Xian Hong, Sullivan Mark D, Ballantyne Jane C, Lustman Patrick J, Grucza Richard, Scherrer Jeffrey F
Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis MO. 63110, USA; Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis MO. 63110, USA.
College of Public Health and Social Justice, Saint Louis University, 3545 Lafayette Ave, St. Louis, MO 63104, USA.
Int J Drug Policy. 2021 Nov;97:103308. doi: 10.1016/j.drugpo.2021.103308. Epub 2021 Jun 4.
Opioid doses declined after the Centers for Disease Control (CDC) opioid prescribing guideline was published. However, it is unknown if dose declines occurred in patients with ≥ 3 years of continuous opioid use.
Optum® de-identified integrated Electronic Health Record and claims data were used to create an adult sample (n = 400) with continuous opioid use for 18 months before and after the guideline publication. Based on the morphine milligram equivalent (MME) distribution at Month 1, patients were categorized into 1-50, 51-100, 101-200, and >200 mg baseline MME. Interrupted time series analysis using segmented mixed linear regression models stratified on baseline MME estimated average monthly changes in MME in the 18-months pre- and post-guideline, before and after adjusting for time-varying pain conditions, psychiatric disorders and benzodiazepine prescription.
Patients were 59.6 (SD±11.8) years of age, 55.8% female and 84.0% white race. For 1-50 MME, monthly dose slope was significantly (p<0.0001) flatter post-guideline (pre b = 0.34 MME/month vs. post b = 0.12 MME/month). For 51-100 MME, the pre- and post-guideline dose slopes did not significantly differ (pre b = 0.60 MME/month vs. post b = 0.27 MME/month). For 101-200 MME, post-guideline dose slope was significantly (p<0.0001) steeper and decreasing post-guideline (pre b = 0.11 MME/month vs. post b= -1.33 MME/month). Among >200 MME, dose decreased in the pre- and post-guideline periods, and post-guideline decline was significantly (p<0.0001) steeper (b= -1. 86 MME/month vs. b= -4.13 MME/month).
Among patients on multiyear opioid therapy, the CDC guideline was associated with a modest change in dosing, except for patients on very high doses. The guideline was not associated with decreasing MME among lower-dose, long-term users.
美国疾病控制中心（CDC）发布阿片类药物处方指南后，阿片类药物剂量有所下降。然而，连续使用阿片类药物≥3年的患者剂量是否下降尚不清楚。
利用Optum®匿名综合电子健康记录和索赔数据，创建了一个成人样本（n = 400），该样本在指南发布前后连续使用阿片类药物18个月。根据第1个月的吗啡毫克当量（MME）分布，将患者分为基线MME为1 - 50、51 - 100、101 - 200和>200 mg的组。使用分段混合线性回归模型进行中断时间序列分析，根据基线MME分层，估计指南发布前后18个月MME的平均每月变化，同时对随时间变化的疼痛状况、精神疾病和苯二氮卓类药物处方进行调整。
患者年龄为59.6（标准差±11.8）岁，女性占55.8%，白人占84.0%。对于1 - 50 MME组，指南发布后每月剂量斜率显著变平（p<0.0001）（指南发布前b = 0.34 MME/月，指南发布后b = 0.12 MME/月）。对于51 - 100 MME组，指南发布前后剂量斜率无显著差异（指南发布前b = 0.60 MME/月，指南发布后b = 0.27 MME/月）。对于101 - 200 MME组，指南发布后剂量斜率显著变陡（p<0.0001）且呈下降趋势（指南发布前b = 0.11 MME/月，指南发布后b = -1.33 MME/月）。在>200 MME组中，指南发布前后剂量均下降，且指南发布后的下降幅度显著更大（p<0.0001）（b = -1.86 MME/月 vs. b = -4.13 MME/月）。
在接受多年阿片类药物治疗的患者中，除了高剂量患者外，CDC指南与剂量的适度变化有关。该指南与低剂量、长期使用者的MME降低无关。
