Tennessee Department of Health, Office of Informatics and Analytics, Nashville, Tennessee.
Tennessee Department of Health, Office of Informatics and Analytics, Nashville, Tennessee.
J Emerg Med. 2022 Jan;62(1):51-63. doi: 10.1016/j.jemermed.2021.07.050. Epub 2021 Sep 15.
Despite increasing trends of nonfatal opioid overdoses in emergency departments (EDs), population-based studies comparing prescription opioid dosing patterns before and after nonfatal opioid overdoses are limited.
To evaluate characteristics of prescribing behaviors before and after nonfatal overdoses, with a focus on opioid dosage.
Included were 5,395 adult residents of Tennessee discharged from hospital EDs after a first nonfatal opioid overdose (2016-2017). Patients were linked to eligible prescription records in the Tennessee Controlled Substance Monitoring Database. We estimated odds ratios (OR) and 95% confidence intervals (CI) to evaluate characteristics associated with filling opioid prescriptions 90 days before overdose and with high daily dose (≥ 90 morphine milligram equivalents) 90 days after overdose.
Among patients who filled a prescription both before and after an overdose, the percentage filling a low, medium, and high dose was 33.7%, 31.9%, and 34.4%, respectively, after an opioid overdose (n = 1,516). Most high-dose users before an overdose (>70%) remained high-dose users with the same prescriber after the overdose. Male gender, ages ≥ 35 years, and medium metro residence were associated with increased odds of high-dose filling after an opioid overdose. Patients filling overlapping opioid-benzodiazepine prescriptions and with > 7 days' supply had increased odds of filling high dose after an opioid overdose (OR 1.4, 95% CI 1.08-1.70 and OR 3.7, 95% CI 2.28-5.84, respectively).
In Tennessee, many patients treated in the ED for an overdose are still prescribed high-dose opioid analgesics after an overdose, highlighting a missed opportunity for intervention and coordination of care between ED and non-ED providers.
尽管急诊科（ED）的非致命性阿片类药物过量呈上升趋势，但将非致命性阿片类药物过量前后的处方阿片类药物剂量模式进行比较的基于人群的研究有限。
评估非致命性药物过量前后的处方行为特征，重点关注阿片类药物的剂量。
纳入了 2016 年至 2017 年在田纳西州医院急诊科首次非致命性阿片类药物过量后出院的 5395 名成年居民。将患者与田纳西州受控物质监测数据库中符合条件的处方记录进行关联。我们估计了比值比（OR）和 95%置信区间（CI），以评估与 90 天前药物过量时开具阿片类药物处方和 90 天后高日剂量（≥90 吗啡毫克当量）相关的特征。
在药物过量前后均开具处方的患者中，阿片类药物过量后开具低、中、高剂量处方的比例分别为 33.7%、31.9%和 34.4%（n=1516）。大多数在药物过量前使用高剂量的患者（>70%）在药物过量后仍使用相同的处方医生开具高剂量处方。男性、年龄≥35 岁和中等城市地区与阿片类药物过量后开具高剂量处方的几率增加相关。同时开具阿片类药物-苯二氮䓬类药物重叠处方和超过 7 天供应量的患者，在阿片类药物过量后开具高剂量的几率增加（OR 1.4，95%CI 1.08-1.70 和 OR 3.7，95%CI 2.28-5.84）。
在田纳西州，许多在急诊科因药物过量而接受治疗的患者在药物过量后仍开具高剂量阿片类药物止痛剂，这表明急诊科和非急诊科提供者之间存在干预和协调护理的机会错失。
