College of Pharmacy, Institute of Therapeutic Innovations and Outcomes (ITIO), The Ohio State University, Columbus, Ohio, USA.
College of Medicine, The Ohio State University, Columbus, Ohio, USA.
J Am Geriatr Soc. 2023 Jan;71(1):98-108. doi: 10.1111/jgs.18102. Epub 2022 Oct 26.
A limited number of studies have analyzed prescribing among Medicare-enrolled adults at risk for opioid overdoses. The objectives of this study were to evaluate prescribing for naloxone and central nervous system (CNS) active medications and to determine the relationships of patient characteristics with exposure to these medications.
This was a retrospective cross-sectional analysis of a Medicare-enrolled medication therapy management eligible cohort. Patients were stratified into two cohorts, individuals with a mean daily morphine milligram equivalent (MME) dose <50 and individuals with MME ≥50. Medications assessed included benzodiazepines, skeletal muscle relaxants (SMR), hypnotics, gabapentanoids, selective-serotonin reuptake inhibitors (SSRI), serotonin-norepinephrine reuptake inhibitors (SNRI), tricyclic antidepressants (TCA), antipsychotics, barbiturates, other antiepileptics, hydroxyzine, and naloxone. Chi-square with odds ratios and logistic regressions determined the relationships of medications and patient characteristics with mean daily MME ≥50. Relationship between medications and opioid dose was adjusted for age and sex.
There were 3452 patients with a daily MME <50 and 1116 with a daily MME ≥50. After adjusting for age and sex, patients with a daily MME ≥50 were more likely to be prescribed hypnotics (OR: 1.41, 95% CI 1.17-1.70), SNRIs (OR: 1.39, 95% CI 1.17-1.64), and naloxone (OR: 3.21, 95% CI 2.49-4.12) (p < 0.001). Nine percent of eligible patients received naloxone. Age groups of persons <85 years of age had 1.58-4.04 (p ≤ 0.004) times the odds of being prescribed a mean daily MME ≥50.
Nearly one-fourth of patients were prescribed a mean daily opioid therapy of MME ≥50. These patients were more likely to be prescribed hypnotics, SNRIs, and naloxone. Patients receiving chronic high-dose opioid therapy were more likely to be in age groups of persons <85 years. Naloxone may be underprescribed among eligible adults. Targeted medication services may ensure optimal prescribing among Medicare patients with chronic opioid therapies.
仅有少数研究分析了医疗保险覆盖的阿片类药物过量风险人群的处方情况。本研究的目的是评估纳洛酮和中枢神经系统（CNS）活性药物的处方情况，并确定患者特征与暴露于这些药物之间的关系。
这是一项医疗保险药物治疗管理合格队列的回顾性横断面分析。患者分为两个队列，平均每日美沙酮毫克当量（MME）剂量<50 的个体和 MME≥50 的个体。评估的药物包括苯二氮䓬类、骨骼肌松弛剂（SMR）、催眠药、加巴喷丁类、选择性 5-羟色胺再摄取抑制剂（SSRI）、5-羟色胺去甲肾上腺素再摄取抑制剂（SNRI）、三环抗抑郁药（TCA）、抗精神病药、巴比妥类、其他抗癫痫药、羟嗪和纳洛酮。卡方检验和比值比以及逻辑回归确定了药物和患者特征与平均每日 MME≥50 的关系。调整年龄和性别后，调整后的平均每日 MME≥50 患者更有可能被处方催眠药（OR：1.41，95%CI 1.17-1.70）、SNRIs（OR：1.39，95%CI 1.17-1.64）和纳洛酮（OR：3.21，95%CI 2.49-4.12）（p<0.001）。有 9%的合格患者接受了纳洛酮治疗。年龄在<85 岁的人群，其被处方平均每日 MME≥50 的几率为 1.58-4.04（p≤0.004）倍。
近四分之一的患者被处方了平均每日 MME≥50 的阿片类药物治疗方案。这些患者更有可能被处方催眠药、SNRIs 和纳洛酮。接受慢性高剂量阿片类药物治疗的患者更可能是年龄在<85 岁的人群。在合格的成年人中，纳洛酮的处方可能不足。有针对性的药物服务可能确保医疗保险患者接受慢性阿片类药物治疗时的药物处方优化。
