2015 - 2018年马萨诸塞州长期阿片类药物治疗的突然停药情况

Abrupt Discontinuation From Long-Term Opioid Therapy in Massachusetts, 2015-2018.

作者信息

Beaugard Corinne A, Chui Kenneth K H, Larochelle Marc R, Young Leonard D, Walley Alexander Y, Stopka Thomas J

机构信息

Boston University School of Social Work, Boston, Massachusetts.

Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts.

出版信息

Am J Prev Med. 2022 Mar;62(3):404-413. doi: 10.1016/j.amepre.2021.09.015. Epub 2021 Nov 24.

DOI:10.1016/j.amepre.2021.09.015

PMID:34838368

Abstract

INTRODUCTION

In response to the opioid overdose crisis, providers were urged to taper and discontinue patients from long-term opioid therapy; however, abrupt discontinuation may lead to poor health outcomes. This study aims to determine abrupt and tapered discontinuation rates and identify the patient and provider characteristics associated with abrupt discontinuation.

METHODS

Data were from the Massachusetts Prescription Monitoring Program, 2015-2018. Patients discontinued from long-term opioid therapy were included in the analysis. Differences between abrupt and tapered discontinuations were identified with bivariate correlations, and variables independently associated with abrupt discontinuation were identified using multivariable Poisson regression analyses. Data were analyzed during 2019-2021.

RESULTS

In total, 277,485 patients experienced 359,320 discontinuations, of which 33.7% (n=120,964) were abrupt. Of all discontinuations, 55.7% were among female patients, and 57.9% were among patients aged >55 years. The ratio of abrupt to tapered discontinuations increased from 1:2.11 in 2015 to 1:1.75 in 2018. In bivariate analysis, prescribers with more patients receiving monthly opioid prescriptions were less likely to abruptly discontinue patients (29.0, IQR=13.9, 55.3 vs 18.8, IQR=5.84, 43.9, p<0.001), as were prescribers who wrote more monthly opioid prescriptions (36.0, IQR=16.8, 70.8 vs 25.4, IQR=7.40, 58.3, p<0.001). Multivariable results indicated that abrupt discontinuation was independently associated with male sex (RR=1.31, 95% CI=1.29, 1.1.32), younger age (RR=0.872, 95% CI=0.869, 0.874), greater distance between patient and prescriber (RR=1.0075, 95% CI=1.0072, 1.0078), and longer long-term opioid therapy duration (RR=1.021, 95% CI=1.021, 1.0122 for every month increase).

CONCLUSIONS

Among all long-term opioid therapy discontinuations, abrupt discontinuation is increasing. Evidence-based approaches to managing and tapering long-term opioid therapy are urgently needed.

摘要

引言

为应对阿片类药物过量危机，医疗机构被敦促减少并停用患者的长期阿片类药物治疗；然而，突然停药可能导致不良健康后果。本研究旨在确定突然停药和逐渐减量停药的发生率，并确定与突然停药相关的患者和医疗机构特征。

方法

数据来自2015 - 2018年马萨诸塞州处方监测项目。纳入分析的是停止长期阿片类药物治疗的患者。通过双变量相关性分析确定突然停药和逐渐减量停药之间的差异，并使用多变量泊松回归分析确定与突然停药独立相关的变量。数据于2019 - 2021年进行分析。

结果

共有277,485名患者经历了359,320次停药，其中33.7%（n = 120,964）为突然停药。在所有停药情况中，55.7%发生在女性患者中，57.9%发生在年龄大于55岁的患者中。突然停药与逐渐减量停药的比例从2015年的1:2.11增加到2018年的1:1.75。在双变量分析中，每月开具阿片类药物处方患者较多的开方者突然停用患者的可能性较小（29.0，四分位间距 = 13.9，55.3 对比 18.8，四分位间距 = 5.84，43.9，p < 0.001），每月开具阿片类药物处方较多的开方者也是如此（36.0，四分位间距 = 16.8，70.8 对比 25.4，四分位间距 = 7.40，58.3，p < 0.001）。多变量结果表明，突然停药与男性性别（风险比 = 1.31，95%置信区间 = 1.29，1.32）、较年轻的年龄（风险比 = 0.872，95%置信区间 = 0.869，0.874）、患者与开方者之间距离较远（风险比 = 1.0075，95%置信区间 = 1.0072，1.0078）以及较长的长期阿片类药物治疗持续时间（每增加一个月，风险比 = 1.021，95%置信区间 = 1.021，1.0122）独立相关。