Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.
College of Medicine, SUNY Upstate Medical University, Syracuse, NY, United States of America.
Am J Emerg Med. 2022 Jan;51:114-118. doi: 10.1016/j.ajem.2021.10.012. Epub 2021 Oct 12.
Medications for opioid use disorder (MOUD) reduce opioid overdose (OD) deaths; however, prevalence and misuse of MOUD in ED patients presenting with opioid overdose are unclear, as are any impacts of existing MOUD prescriptions on subsequent OD severity.
This was a prospective observational cohort of ED patients with opioid OD at two tertiary-care hospitals from 2015 to 19. Patients with confirmed opioid OD (via urine toxicology) were included, while patients with alternate diagnoses, insufficient data, age < 18, and prisoners were excluded. OD severity was defined using: (a) hospital LOS (days); and (b) in-hospital mortality. Time trends by calendar year and associations between MOUD and study outcomes were calculated.
In 2829 ED patients with acute drug OD, 696 with confirmed opioid OD were included. Overall, 120 patients (17%) were previously prescribed any MOUD, and MOUD prevalence was significantly higher in 2018 and 2019 compared to 2016 (20.1% and 27.8% vs. 8.8%, p < 0.05). Odds of MOUD misuse were significantly higher for methadone (OR 3.96 95% CI 2.57-6.12) and lowest for buprenorphine (OR 1.16, p = NS). Mean LOS was over 50% longer for methadone (3.08 days) compared to buprenorphine and naltrexone (both 2.0 days, p = NS). Following adjustment for confounders, buprenorphine use was associated with significantly shorter LOS (IRR -0.44 (95%CI -0.85, -0.04)). Odds of death were 30% lower for patients on any MOUD (OR 0.70, 95%CI 0.09-5.72), but highest in the methadone group (OR 0.82, 95%CI 0.10-6.74).
While MOUD prevalence significantly increased over the study period, MOUD misuse occurred for patients taking methadone, and OD LOS overall was lower in patients with any prior buprenorphine prescription.
阿片类药物使用障碍（MOUD）药物可降低阿片类药物过量（OD）死亡；然而，在因阿片类药物过量而就诊的急诊患者中，MOUD 的流行程度和滥用情况尚不清楚，现有的 MOUD 处方对随后的 OD 严重程度的影响也不清楚。
这是一项在 2015 年至 2019 年期间在两家三级保健医院进行的前瞻性观察性队列研究，纳入了有明确阿片类药物 OD（通过尿液毒物学检测）的急诊患者，排除了有其他诊断、数据不足、年龄＜18 岁和囚犯的患者。OD 严重程度通过以下两种方式定义：（a）住院时间（天）；（b）院内死亡率。根据日历年度计算 MOUD 与研究结果之间的时间趋势和关联。
在 2829 例因急性药物 OD 就诊的 ED 患者中，有 696 例经确认有阿片类 OD，其中 120 例（17%）之前曾接受过任何 MOUD 治疗，与 2016 年相比，2018 年和 2019 年 MOUD 的流行率显著更高（20.1%和 27.8% vs. 8.8%，p＜0.05）。美沙酮（OR 3.96，95%CI 2.57-6.12）和丁丙诺啡（OR 1.16，p=NS）的 MOUD 误用几率显著更高。与丁丙诺啡和纳曲酮（均为 2.0 天，p=NS）相比，美沙酮的平均 LOS 长 50%以上（3.08 天）。调整混杂因素后，丁丙诺啡的使用与 LOS 显著缩短（IRR-0.44（95%CI-0.85，-0.04））相关。任何 MOUD 治疗的患者死亡风险降低 30%（OR 0.70，95%CI 0.09-5.72），但美沙酮组的风险最高（OR 0.82，95%CI 0.10-6.74）。
虽然在研究期间 MOUD 的流行率显著增加，但美沙酮的滥用在服用美沙酮的患者中发生，而有任何丁丙诺啡处方史的患者 OD 的 LOS 总体较低。
