Ghose Riya, Cowden Fiona, Veluchamy Abirami, Smith Blair H, Colvin Lesley A
Department of Medicine, School of Medicine, University of Dundee, Dundee, UK.
Tayside Substance Misuse Service, Dundee, UK.
Br J Pain. 2022 Aug;16(4):458-466. doi: 10.1177/20494637221095447. Epub 2022 May 24.
There are concerns about rising drug-related deaths and the potential contribution of prescription analgesics. There is limited understanding regarding the role of prescription analgesics in non-fatal overdoses (NFODs), nor is there a good understanding of what factors are associated with more severe overdose.
To explore risk factors and characteristics of NFODs among people attending a specialist community-based substance misuse service.
After Caldicott approval, data on NFODs, in people attending the Tayside Substance Misuse Service (TSMS), were extracted from the Scottish Ambulance Service database, along with opioid replacement therapy (ORT) prescribing data. Statistical analysis was performed using R studio and Microsoft Excel.
557 people (78% [434/556] male, mean age ± standard deviation 38.4 ± 7.95) had an NFOD. Repeat NFODs were more likely in males compared to females ( < .0065). Males were more likely to be administered naloxone (OR = 1.94, 95% CI = 1.10-3.40, < .02). NFODs at home were more likely to be moderate to severe (categorized by Glasgow Comma Scale [ < .02, OR = 4.95, 95% CI = 1.24-24.38]). Methadone (321/557, 57.63%), benzodiazepines (281/557, 50.45%) and heroin (244/557, 43.81%) were the commonest substances: prescribed methadone overdose was more likely than buprenorphine ( < .00001). Opioids and benzodiazepines were often taken together (275/557, 49.40%), with almost all gabapentinoid NFODs also involving opioids (60/61, 98.40%).
Polysubstance use with opioids prescribed for ORT, such as methadone, is highly likely to be implicated in NFOD, with males being at the highest risk of severe and repeat NFOD. Future work should focus on strategies to further reduce NFODs.
人们对与药物相关的死亡人数上升以及处方镇痛药的潜在影响感到担忧。对于处方镇痛药在非致命性药物过量（NFOD）中的作用了解有限，对于哪些因素与更严重的药物过量相关也缺乏充分认识。
探讨在一家专门的社区药物滥用服务机构就诊的人群中NFOD的危险因素和特征。
经考迪科特委员会批准后，从苏格兰救护车服务数据库中提取了泰赛德药物滥用服务（TSMS）就诊人群的NFOD数据以及阿片类药物替代疗法（ORT）处方数据。使用R studio和微软Excel进行统计分析。
557人（78%[434/556]为男性，平均年龄±标准差为38.4±7.95）发生了NFOD。与女性相比，男性更易出现反复NFOD（P<0.0065）。男性更有可能接受纳洛酮治疗（比值比[OR]=1.94，95%置信区间[CI]=1.10 - 3.40，P<0.02）。在家中发生的NFOD更有可能为中度至重度（根据格拉斯哥昏迷量表分类，P<0.02，OR = 4.95，95%CI = 1.24 - 24.38）。美沙酮（321/557，57.63%）、苯二氮䓬类药物（281/557，50.45%）和海洛因（244/557，43.81%）是最常见的物质：处方美沙酮过量比丁丙诺啡更常见（P<0.00001）。阿片类药物和苯二氮䓬类药物常一起服用（275/557，49.40%），几乎所有加巴喷丁类NFOD也涉及阿片类药物（60/61，98.40%）。
与用于ORT的阿片类药物（如美沙酮）联合使用多种物质极有可能与NFOD有关，男性发生严重和反复NFOD的风险最高。未来的工作应侧重于进一步减少NFOD的策略。
