Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
ICES, Toronto, Ontario, Canada.
J Spinal Cord Med. 2023 Nov;46(6):881-888. doi: 10.1080/10790268.2021.1969503. Epub 2021 Oct 26.
To describe the proportion and identify predictors of community-dwelling individuals with traumatic spinal cord injury (TSCI) who were dispensed ≥1 publicly funded opioid in the year after injury using a retrospective cohort study.
Ontario, Canada.
PARTICIPANTS, INTERVENTIONS, OUTCOME MEASURES: We used administrative data to identify predictors of receiving publicly funded prescription opioids during the year after injury for individuals who were injured between April 2004 and March 2015. Our outcome was modeled using robust Poisson multivariable regression and we reported adjusted relative risks (aRR) with 95% confidence intervals.
In our retrospective cohort of 934 individuals with TSCI who were eligible for the provincial drug program, 510 (55%) received ≥1 prescription opioid in the year after their injury. Most individuals were male (71%) and the median age was 63 years (interquartile range: 42-72). Being male (aRR 1.15, 95% confidence interval [CI] 1.01-1.31), having chronic obstructive pulmonary disease (aRR 1.25, 95% CI 1.05-1.50), and using prescription opioids before injury (aRR 1.46, 95% CI 1.29-1.66) were significantly associated with receiving opioids in the year after TSCI. Short durations of hospital stay after injury were also identified as being a significant risk factor of outpatient opioid use (aRR = 1.28, 95% CI = 1.08-1.51) when compared to longer hospital stays.
This study presented evidence showing that most individuals eligible for Ontario's public drug program who experienced a TSCI used opioids in the year following their injury. Due to the paucity of research on this population and their potential for elevated risks of adverse events, it is important for additional studies to be conducted on opioid use in this population to understand short-term and long-term risks and benefits.
通过回顾性队列研究，描述受伤后一年内接受≥1 种公共资助阿片类药物的社区居住外伤性脊髓损伤（TSCI）患者的比例，并确定其预测因素。
加拿大安大略省。
参与者、干预措施、结局测量：我们使用行政数据来确定 2004 年 4 月至 2015 年 3 月期间受伤的个体在受伤后一年内接受公共资助处方阿片类药物的预测因素。我们使用稳健泊松多变量回归对我们的结果进行建模，并报告了调整后的相对风险（aRR）及其 95%置信区间。
在我们的 934 名符合省级药物计划条件的 TSCI 患者回顾性队列中，有 510 名（55%）在受伤后一年内接受了≥1 种处方阿片类药物。大多数患者为男性（71%），中位年龄为 63 岁（四分位距：42-72）。男性（aRR 1.15，95%置信区间 [CI] 1.01-1.31）、慢性阻塞性肺疾病（aRR 1.25，95% CI 1.05-1.50）和受伤前使用处方阿片类药物（aRR 1.46，95% CI 1.29-1.66）与 TSCI 后一年内接受阿片类药物治疗显著相关。与较长的住院时间相比，受伤后住院时间较短也被确定为门诊使用阿片类药物的显著危险因素（aRR=1.28，95% CI=1.08-1.51）。
这项研究提供了证据，表明安大略省公共药物计划中大多数符合条件的外伤性脊髓损伤患者在受伤后一年内使用了阿片类药物。由于对这一人群的研究很少，而且他们有发生不良事件风险升高的可能性，因此需要对这一人群的阿片类药物使用情况进行更多的研究，以了解短期和长期的风险和获益。
