Department of Family and Preventive Medicine, University of Utah, 375 Chipeta Way Ste A, Salt Lake City, UT, 84108, USA.
Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, 3939 Woodward Ave., Detroit, United States, 48201, USA.
Addiction. 2022 Feb;117(2):457-471. doi: 10.1111/add.15643. Epub 2021 Aug 16.
To assess whether naloxone prescribing in clinical contexts targeted pain patients most at risk for opioid overdose.
A retrospective cohort study using data from the Health Facts Database.
Over 600 United States healthcare facilities.
Three patient groups were followed for 2 years during 2009 to 2017: individuals with shoulder or long bone fractures (n = 252 424), chronic pain syndrome (CPS) (n = 76 141), or non-traumatic low back pain (n = 792 956) who received an opioid prescription. Groups were chosen based on previous work.
The outcome was opioid overdose identified by International Classification of Diseases codes (ICDs) and the primary predictor was number of naloxone prescriptions identified by National Drug Codes (NDCs).
Opioid overdoses occurred among 0.16% of fracture patients (average follow-up time to overdose [AFU] = 240 days), 1.28% of CPS patients (AFU = 244 days), and 0.30% low back pain patients (AFU = 264 days). A total of 58 083 bone fracture patients received naloxone prescriptions, and naloxone prescription was associated with subsequent opioid overdose (hazard ratio [HR] = 1.87, 95% CI = 1.68-2.09), and number of subsequent overdoses (incidence rate ratio [IRR] = 1.89, 95% CI = 1.69-2.12). A total of 19 529 CPS patients received naloxone prescriptions, and naloxone prescription was associated with subsequent opioid overdose (HR = 1.69, 95% CI = 1.61-1.78) and number of subsequent overdoses (IRR = 1.74, 95% CI = 1.67-1.83). A total of 110 608 low back pain patients received naloxone prescriptions, and naloxone prescription was associated with subsequent opioid overdose (HR = 1.33, 95% CI = 1.27-1.40) and number of subsequent overdoses (IRR = 1.35, 95% CI = 1.29-1.41).
Receiving a naloxone prescription appears to be associated with increased risk of subsequent opioid overdose among patients with acute and chronic pain, suggesting prescribers often identify patients most in need of naloxone.
评估在临床环境中开具纳洛酮处方是否针对阿片类药物过量风险最高的疼痛患者。
使用来自 Health Facts Database 的数据进行回顾性队列研究。
美国 600 多家医疗保健机构。
在 2009 年至 2017 年期间的 2 年中，对三组患者进行了随访：肩或长骨骨折患者（n=252424）、慢性疼痛综合征（CPS）患者（n=76141）和非创伤性腰痛患者（n=792956），他们都接受了阿片类药物处方。这些组是基于之前的工作选择的。
结果是通过国际疾病分类代码（ICD）确定的阿片类药物过量，主要预测因子是通过国家药物代码（NDC）确定的纳洛酮处方数量。
骨折患者中有 0.16%发生阿片类药物过量（平均随访至过量时间[AFU]为 240 天），CPS 患者中有 1.28%（AFU 为 244 天），腰痛患者中有 0.30%（AFU 为 264 天）。共有 58083 名骨骨折患者接受了纳洛酮处方，纳洛酮处方与随后的阿片类药物过量（风险比[HR]为 1.87，95%置信区间[CI]为 1.68-2.09）和随后的过量次数（发病率比[IRR]为 1.89，95%CI 为 1.69-2.12）相关。共有 19529 名 CPS 患者接受了纳洛酮处方，纳洛酮处方与随后的阿片类药物过量（HR 为 1.69，95%CI 为 1.61-1.78）和随后的过量次数（IRR 为 1.74，95%CI 为 1.67-1.83）相关。共有 110608 名腰痛患者接受了纳洛酮处方，纳洛酮处方与随后的阿片类药物过量（HR 为 1.33，95%CI 为 1.27-1.40）和随后的过量次数（IRR 为 1.35，95%CI 为 1.29-1.41）相关。
在急性和慢性疼痛患者中，接受纳洛酮处方似乎与随后发生阿片类药物过量的风险增加有关，这表明开处方者通常会确定最需要纳洛酮的患者。
Zotero 插件