加巴喷丁、阿片类药物和苯二氮䓬类药物同时使用相关的不良结局：一项巢式病例对照研究。

Adverse outcomes associated with concurrent gabapentin, opioid, and benzodiazepine utilization: A nested case-control study.

作者信息

Olopoenia Abisola, Camelo-Castillo Wendy, Qato Danya M, Adekoya Adepeju, Palumbo Frank, Sera Leah, Simoni-Wastila Linda

机构信息

Department of Pharmaceutical Health Services Research, University of Maryland Baltimore, Baltimore, MD, USA.

School of Medicine, University of Maryland Baltimore, Baltimore, MD, USA.

出版信息

Lancet Reg Health Am. 2022 Jun 23;13:100302. doi: 10.1016/j.lana.2022.100302. eCollection 2022 Sep.

DOI:10.1016/j.lana.2022.100302

PMID:36777316

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9904085/

Abstract

BACKGROUND

Gabapentin, opioids, and/or benzodiazepines are commonly prescribed for a variety of pain and psychiatric conditions. Despite the high likelihood of co-prescription of these medications, little is known about co-utilization of gabapentin (GABA), opioids (OP), and benzodiazepines (BZD) and associated public health outcomes.

METHODS

Using Medicare CCW Data, 2013-2016, we conducted a nested case-control study to examine the association between concurrent utilization of GABA, OP, and BZD and respiratory depression, opioid, and substance-related overdose among Medicare disabled beneficiaries. Cases and controls were Fee-for-service disabled beneficiaries who had a diagnosis of acute pain (AP), chronic pain (CP) or mental health conditions (MH) and received GABA, OP or BZD. Cases with respiratory depression, opioid or substance-related overdose were matched with up to 4 controls on socio-demographics, year of cohort entry and disease risk score. Primary exposure was concurrent medication utilization defined as an overlap of at least one day in prescriptions for GABA, OP and BZD.

FINDINGS

Across all cohorts, the majority of cases and controls were under 65, female, dually eligible and had prior histories of pain and mental health conditions. GABA+OP+BZD use was associated with increased odds of respiratory depression [AOR(95%CI)-AP: 1.35 (1.19-1.52), CP:1.24 (1.11-1.38) and MH: 1.16 (1.02-1.32) vs. OP only], opioid-related overdose [AP: 1.43 (1.04-1.98), CP: 1.47 (1.07-2.00) and MH: 1.44 (1.04-2.00) vs. OP only], and substance-related overdose [AP: 1.77 (1.26-2.50), CP: 1.70 (1.24-2.34) and MH: 1.92 (1.31-2.82) vs. GABA only]. While there were cohort differences in the association between GABA+OP and both respiratory depression and opioid-related overdose, GABA+OP and GABA+BZD use were associated with significantly higher odds of substance-related overdose across all clinical cohorts.

INTERPRETATION

Among Medicare disabled beneficiaries, concurrent utilization of gabapentin, opioids, and benzodiazepines is associated with multiple adverse outcomes. Given this, it is imperative that the benefits and risks of co-prescribing these medications be comprehensively examined.

FUNDING

None.

摘要

背景

加巴喷丁、阿片类药物和/或苯二氮䓬类药物常用于治疗各种疼痛和精神疾病。尽管这些药物联合处方的可能性很高，但对于加巴喷丁（GABA）、阿片类药物（OP）和苯二氮䓬类药物（BZD）的联合使用情况及其相关的公共卫生结果却知之甚少。

方法

利用2013 - 2016年医疗保险连续护理数据（Medicare CCW Data），我们进行了一项巢式病例对照研究，以探讨医疗保险残疾受益人中GABA、OP和BZD同时使用与呼吸抑制、阿片类药物及物质相关过量用药之间的关联。病例组和对照组为按服务收费的残疾受益人，他们被诊断患有急性疼痛（AP）、慢性疼痛（CP）或精神健康疾病（MH），并接受了GABA、OP或BZD治疗。患有呼吸抑制、阿片类药物或物质相关过量用药的病例与多达4名对照组在社会人口统计学、队列进入年份和疾病风险评分方面进行匹配。主要暴露因素为同时使用药物，定义为GABA、OP和BZD的处方至少有一天重叠。

研究结果

在所有队列中，大多数病例和对照年龄在65岁以下，为女性，具有双重资格，且有疼痛和精神健康疾病史。与仅使用OP相比，同时使用GABA + OP + BZD与呼吸抑制几率增加相关 [调整后比值比（AOR）（95%置信区间）- AP：1.35（1.19 - 1.52），CP：1.24（1.11 - 1.38），MH：1.16（1.02 - 1.32）]、阿片类药物相关过量用药 [AP：1.43（1.04 - 1.98），CP：1.47（1.07 - 2.00），MH：1.44（1.04 - 2.00）] 以及物质相关过量用药 [AP：1.77（1.26 - 2.50），CP：1.70（1.24 - 2.34），MH：1.92（1.31 - 2.82）与仅使用GABA相比]。虽然GABA + OP与呼吸抑制和阿片类药物相关过量用药之间的关联存在队列差异，但在所有临床队列中，GABA + OP和GABA + BZD的使用与物质相关过量用药的几率显著更高相关。