Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX, USA.
Department of Emergency Medicine, Philadelphia College of Osteopathic Medicine & Bayhealth Medical Center, Dover, DE, USA.
Clin Toxicol (Phila). 2022 Apr;60(4):499-506. doi: 10.1080/15563650.2021.1981362. Epub 2021 Sep 23.
Older adults are less likely than younger adults to receive naloxone therapy. Given high rates of prescription opioid use/misuse and increasing illicit opioid use among older adults, factors associated with naloxone administration for older opioid poisoning cases need examination.
We analyzed the 83,135 opioid-involved cases aged 50+ from the 2015-2020 National Poison Data System. Single-variable logistic regression was used to examine associations of naloxone administration with demographic factors, exposure site/reason, medical outcomes, management site/level of care, clinical effects, and other interventions. Multivariable logistic regression models were fit to examine associations of naloxone administration with different types of opioids.
Over the six years, the proportion of prescription opioid cases that received naloxone therapy increased steadily from 21.9% to 28.4%. The proportion of illicit opioid cases that received naloxone therapy was 51.9% in 2015 and 59.8% in 2020 with a high of 64.4% in 2019. In 2020, the death rate for illicit opioid cases without naloxone therapy was 31.4% compared to 2.3% for those with the therapy. Cases managed at healthcare facilities (HCF) had higher odds of receiving naloxone therapy. Among prescription opioid cases, naloxone therapy rates among older and female cases and those managed at non-HCF settings were especially low even for major medical outcomes. Cases involving oxycodone, morphine, methadone, prescription fentanyl, hydromorphone, oxymorphone, and other/unknown opioids had higher odds of naloxone administration.
Rates of naloxone therapy for older prescription opioid poisoning cases need improvement. While rates were higher among illicit opioid cases, the drop in 2020 and the sharp increase in deaths among illicit opioid cases without naloxone therapy confirm the importance of access to this life-saving intervention.
Increased naloxone co-prescribing and other means of facilitating access to naloxone are needed to prevent opioid poisoning deaths among older adults who use prescription opioids.
老年人接受纳洛酮治疗的可能性低于年轻人。鉴于老年人处方类阿片药物使用/滥用率高，以及非法类阿片药物使用不断增加，有必要研究与老年阿片类药物中毒病例中纳洛酮给药相关的因素。
我们分析了 2015 年至 2020 年国家毒物数据系统中年龄在 50 岁及以上的 83135 例阿片类药物中毒病例。采用单变量逻辑回归分析纳洛酮给药与人口统计学因素、暴露地点/原因、医疗结局、管理地点/护理水平、临床效果和其他干预措施的相关性。采用多变量逻辑回归模型分析纳洛酮给药与不同类型阿片类药物的相关性。
在六年期间，接受纳洛酮治疗的处方类阿片药物中毒病例比例从 21.9%稳步上升至 28.4%。接受纳洛酮治疗的非法类阿片药物中毒病例比例在 2015 年为 51.9%，在 2020 年为 59.8%，2019 年达到最高的 64.4%。2020 年，未接受纳洛酮治疗的非法类阿片药物中毒病例死亡率为 31.4%，而接受治疗的病例死亡率为 2.3%。在医疗机构（HCF）接受治疗的病例更有可能接受纳洛酮治疗。在处方类阿片药物中毒病例中，老年和女性病例以及在非 HCF 环境中接受治疗的病例接受纳洛酮治疗的比例特别低，即使是在出现主要医疗结局的情况下。涉及羟考酮、吗啡、美沙酮、处方类芬太尼、氢吗啡酮、羟吗啡酮和其他/未知阿片类药物的病例更有可能接受纳洛酮治疗。
需要提高老年处方类阿片药物中毒病例接受纳洛酮治疗的比例。虽然非法类阿片药物中毒病例的比例较高，但 2020 年的下降以及没有接受纳洛酮治疗的非法类阿片药物中毒病例的死亡率急剧上升，证实了获得这种救命干预措施的重要性。
需要增加纳洛酮的联合处方和其他促进纳洛酮获取的手段，以预防使用处方类阿片药物的老年人发生阿片类药物中毒死亡。
