与药物辅助治疗期间阿片类药物过量相关的因素：我们如何识别高危个体？
Factors associated with opioid overdose during medication-assisted treatment: How can we identify individuals at risk?
机构信息
Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
Department of Psychiatry and Behavioral Neurosciences, McMaster University, 100 West 5th St, Hamilton, ON, L8N 3K7, Canada.
出版信息
Harm Reduct J. 2021 Jul 8;18(1):71. doi: 10.1186/s12954-021-00521-4.
BACKGROUND
Due to the loss of tolerance to opioids during medication-assisted treatment (MAT), this period may represent a time of heightened risk for overdose. Identifying factors associated with increased risk of overdose during treatment is therefore paramount to improving outcomes. We aimed to determine the prevalence of opioid overdoses in patients receiving MAT. Additionally, we explored factors associated with opioid overdose during MAT and the association between length of time enrolled in MAT and overdose.
METHODS
Data were collected prospectively from 2360 participants receiving outpatient MAT in Ontario, Canada. Participants were divided into three groups by overdose status: no history of overdose, any lifetime history of overdose, and emergency department visit for opioid overdose in the last year. We used a multivariate multinomial regression model to assess demographic and clinical factors associated with overdose status.
RESULTS
Twenty-four percent of participants reported a lifetime history of overdose (n = 562), and 8% reported an emergency department (ED) visit for opioid overdose in the last year (n = 179). Individuals with a recent ED visit for opioid overdose were in treatment for shorter duration (odds ratio [OR] 0.92, 95% confidence interval [CI] 0.87, 0.97, p = 0.001). Individuals with a lifetime or recent history of overdose were more likely to be younger in age (OR 0.93, 95% CI 0.89, 0.98, p = 0.007 and OR 0.84, 95% CI 0.77, 0.92, p < 0.001, respectively), report more physical symptoms (OR 1.02, 95% CI 1.01, 1.03, p = 0.005 and OR 1.03, 95% CI 1.01, 1.05, p = 0.005, respectively), and had higher rates of non-prescription benzodiazepine use (OR 1.87, 95% CI 1.32, 2.66, p < 0.001 and OR 2.34, 95% CI 1.43, 3.81, p = 0.001, respectively) compared to individuals with no history of overdose.
CONCLUSIONS
A considerable number of patients enrolled in MAT have experienced overdose. Our study highlights that there are identifiable factors associated with a patient's overdose status that may represent areas for intervention. In particular, longer duration in MAT is associated with a decreased risk of overdose.
背景
由于在药物辅助治疗（MAT）期间对阿片类药物的耐受性丧失，这一时期可能代表着药物过量的风险增加。因此，确定与治疗期间药物过量风险增加相关的因素对于改善治疗结果至关重要。我们旨在确定接受 MAT 的患者中药物过量的发生率。此外，我们还探讨了与 MAT 期间药物过量相关的因素，以及在 MAT 中登记的时间长短与药物过量之间的关联。
方法
数据是从加拿大安大略省接受门诊 MAT 的 2360 名参与者中前瞻性收集的。参与者根据药物过量情况分为三组：无药物过量史、有终生药物过量史和去年因阿片类药物过量就诊于急诊室。我们使用多变量多项回归模型来评估与药物过量状态相关的人口统计学和临床因素。
结果
24%的参与者报告有终生药物过量史（n=562），8%的参与者报告在过去一年中有因阿片类药物过量就诊于急诊室的经历（n=179）。最近因阿片类药物过量就诊于急诊室的个体治疗持续时间较短（比值比[OR]0.92，95%置信区间[CI]0.87，0.97，p=0.001）。有终生或近期药物过量史的个体更年轻（OR 0.93，95%CI 0.89，0.98，p=0.007 和 OR 0.84，95%CI 0.77，0.92，p<0.001，分别），报告更多的身体症状（OR 1.02，95%CI 1.01，1.03，p=0.005 和 OR 1.03，95%CI 1.01，1.05，p=0.005，分别），并且非处方苯二氮䓬类药物的使用率更高（OR 1.87，95%CI 1.32，2.66，p<0.001 和 OR 2.34，95%CI 1.43，3.81，p=0.001，分别）与无药物过量史的个体相比。
结论
相当数量接受 MAT 的患者经历过药物过量。我们的研究强调，有一些可识别的与患者药物过量状态相关的因素，这些因素可能代表了干预的领域。特别是，MAT 中登记的时间长短与药物过量风险降低有关。
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