Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States of America.
Harvard Medical School, Boston, Massachusetts, United States of America.
PLoS One. 2022 Apr 5;17(4):e0266561. doi: 10.1371/journal.pone.0266561. eCollection 2022.
Hydrocodone and oxycodone are prescribed commonly to treat pain. However, differences in risk of opioid-related adverse outcomes after an initial prescription are unknown. This study aims to determine the risk of opioid-related adverse events, defined as either chronic use or opioid overdose, following a first prescription of hydrocodone or oxycodone to opioid naïve patients.
A retrospective analysis of multiple linked public health datasets in the state of Oregon. Adult patients ages 18 and older who a) received an initial prescription for oxycodone or hydrocodone between 2015-2017 and b) had no opioid prescriptions or opioid-related hospitalizations or emergency department visits in the year preceding the prescription were followed through the end of 2018. First-year chronic opioid use was defined as ≥6 opioid prescriptions (including index) and average ≤30 days uncovered between prescriptions. Fatal or non-fatal opioid overdose was indicated from insurance claims, hospital discharge data or vital records.
After index prescription, 2.8% (n = 14,458) of individuals developed chronic use and 0.3% (n = 1,480) experienced overdose. After adjustment for patient and index prescription characteristics, patients receiving oxycodone had lower odds of developing chronic use relative to patients receiving hydrocodone (adjusted odds ratio = 0.95, 95% confidence interval (CI) 0.91-1.00) but a higher risk of overdose (adjusted hazard ratio (aHR) = 1.65, 95% CI 1.45-1.87). Oxycodone monotherapy appears to greatly increase the hazard of opioid overdose (aHR 2.18, 95% CI 1.86-2.57) compared with hydrocodone with acetaminophen. Oxycodone combined with acetaminophen also shows a significant increase (aHR 1.26, 95% CI 1.06-1.50), but not to the same extent.
Among previously opioid-naïve patients, the risk of developing chronic use was slightly higher with hydrocodone, whereas the risk of overdose was higher after oxycodone, in combination with acetaminophen or monotherapy. With a goal of reducing overdose-related deaths, hydrocodone may be the favorable agent.
氢可酮和羟考酮常用于治疗疼痛。然而，初始处方后与阿片类药物相关的不良结局的风险差异尚不清楚。本研究旨在确定氢可酮或羟考酮初始处方后，定义为慢性使用或阿片类药物过量的与阿片类药物相关的不良事件风险，适用于阿片类药物初治患者。
俄勒冈州多个公共卫生数据集的回顾性分析。年龄在 18 岁及以上的患者，a）在 2015-2017 年期间收到羟考酮或氢可酮的初始处方，b）在处方前一年没有阿片类药物处方或与阿片类药物相关的住院或急诊就诊，随访至 2018 年底。第一年慢性阿片类药物使用定义为≥6 次阿片类药物处方（包括索引）和两次处方之间平均≤30 天无覆盖。保险索赔、出院数据或死亡记录表明存在致命或非致命的阿片类药物过量。
索引处方后，2.8%（n=14458）的患者出现慢性使用，0.3%（n=1480）的患者发生过量使用。在调整患者和索引处方特征后，接受羟考酮的患者发生慢性使用的可能性低于接受氢可酮的患者（调整后的优势比=0.95，95%置信区间（CI）0.91-1.00），但过量使用的风险更高（调整后的危险比（aHR）=1.65，95%CI 1.45-1.87）。与氢可酮与对乙酰氨基酚合用相比，羟考酮单药治疗似乎大大增加了阿片类药物过量的危险（aHR 2.18，95%CI 1.86-2.57）。羟考酮与对乙酰氨基酚合用也有显著增加（aHR 1.26，95%CI 1.06-1.50），但程度较轻。
在以前未使用过阿片类药物的患者中，氢可酮的慢性使用风险略高，而与乙酰氨基酚合用或单用时，羟考酮的过量风险更高。为了减少与过量相关的死亡，氢可酮可能是更有利的药物。
