Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Harvard Medical School, Boston, Massachusetts, USA.
Acad Emerg Med. 2023 Aug;30(8):851-858. doi: 10.1111/acem.14710. Epub 2023 Apr 2.
To determine the impact of personalized risk communication and opioid prescribing on nonprescribed opioid use, we conducted a secondary analysis of randomized controlled trial participants followed prospectively for 90 days after an emergency department (ED) visit for acute back or kidney stone pain.
A total of 1301 individuals were randomized during an encounter at four academic EDs into a probabilistic risk tool (PRT) arm, a narrative-enhanced PRT arm, or a general risk information arm (control). In this secondary analysis, both risk tool arms were combined and compared with the control arm. We used logistic regressions to determine associations between receiving personalized risk information, receiving an opioid prescription in the ED, and nonprescribed opioid use in general and by race.
Complete follow-up data were available for 851 participants; 23.3% (n = 198) were prescribed opioids (34.2% of White vs. 11.6% of Black participants, p < 0.001). Fifty-six (6.6%) participants used nonprescribed opioids. Participants in the personalized risk communication arms had lower nonprescribed opioid use odds (adjusted odds ratio [aOR] 0.58, 95% confidence interval [CI] 0.4-0.83). Black versus White participants had greater nonprescribed opioid use odds (aOR 3.47, 95% CI 2.05-5.87, p < 0.001). Black participants who were prescribed opioids had a lower marginal probability of using nonprescribed opioids versus those who were not (0.06, 95% CI 0.04-0.08, p < 0.001 vs. 0.10, 95% CI 0.08-0.11, p < 0.001). The absolute risk difference in nonprescribed opioid use for Black and White participants, respectively, in the risk communication versus the control arm, was 9.7% and 0.1% (relative risk ratio 0.43 vs. 0.95).
Among Black but not White participants, personalized opioid risk communication and opioid prescribing were associated with lower odds of nonprescribed opioid use. Our findings suggest that racial disparities in opioid prescribing-which have been previously described within the context of this trial-may paradoxically increase nonprescribed opioid use. Personalized risk communication may effectively reduce nonprescribed opioid use, and future research should be designed specifically to explore this possibility in a larger cohort.
为了确定个性化风险沟通和阿片类药物处方对非处方阿片类药物使用的影响，我们对前瞻性随访 90 天的接受急诊（ED）治疗急性背痛或肾结石疼痛的随机对照试验参与者进行了二次分析。
在四个学术 ED 就诊时，共有 1301 名参与者被随机分配到概率风险工具（PRT）组、增强叙事的 PRT 组或一般风险信息组（对照组）。在这项二次分析中，将两个风险工具组合并并与对照组进行比较。我们使用逻辑回归来确定接受个性化风险信息、在 ED 开具阿片类药物处方以及一般和按种族使用非处方阿片类药物之间的关联。
851 名参与者完成了完整的随访数据；23.3%（n=198）开具了阿片类药物（白人参与者的 34.2% vs. 黑人参与者的 11.6%，p<0.001）。56 名（6.6%）参与者使用了非处方阿片类药物。个性化风险沟通组的非处方阿片类药物使用可能性较低（调整后的优势比[aOR]0.58，95%置信区间[CI]0.4-0.83）。黑人参与者比白人参与者使用非处方阿片类药物的可能性更大（aOR 3.47，95%CI 2.05-5.87，p<0.001）。与未开具阿片类药物的黑人参与者相比，开具阿片类药物的黑人参与者使用非处方阿片类药物的边际概率更低（0.06，95%CI 0.04-0.08，p<0.001 与 0.10，95%CI 0.08-0.11，p<0.001）。在风险沟通组与对照组相比，黑人参与者和白人参与者非处方阿片类药物使用的绝对风险差异分别为 9.7%和 0.1%（相对风险比 0.43 与 0.95）。
在黑人参与者中，但在白人参与者中没有，个性化阿片类药物风险沟通和阿片类药物处方与非处方阿片类药物使用的可能性降低相关。我们的研究结果表明，先前在该试验背景下描述的阿片类药物处方种族差异可能会增加非处方阿片类药物的使用。个性化风险沟通可能会有效减少非处方阿片类药物的使用，未来的研究应专门设计在更大的队列中探索这种可能性。
