School of Pharmacy, University of California, San Francisco, San Francisco, CA, USA.
California Poison Control System, San Francisco, CA, USA.
Clin Toxicol (Phila). 2023 Apr;61(4):305-311. doi: 10.1080/15563650.2022.2158095. Epub 2023 Mar 29.
In March 2016, the Centers for Disease Control and Prevention released the Guideline for Prescribing Opioids for Chronic Pain, intended for primary care clinicians. One recommendation advised against concurrent prescription of opioids and benzodiazepines. Although existing research suggests a reduction in co-prescribing of these drug classes by clinicians after guideline release, there are limited data assessing its possible effect on patient medical outcomes, such as overdoses.
This retrospective observational study analyzed opioid and benzodiazepine exposures, alone or in combination, reported to the California Poison Control System from January 2012 to June 2021. Interrupted time series analyses identified the difference in monthly call volume between pre- and post-guideline release. For exposures resulting in serious medical outcomes, additional analyses assessed trends and identified associated variables.
There was no significant change in concomitant opioid and benzodiazepine exposures reported to California Poison Control System between pre- and post-guideline release. Compared to pre-guideline release, exposures to a single opioid or to a single benzodiazepine significantly decreased by 1.07 (95% CI: -1.62, -0.51) and 1.82 (95% CI: -2.33, -1.31) calls per month, respectively, after the guideline release. For exposure calls associated with serious medical outcomes, there was a significant increase of 0.11 (95% CI: 0.04, 0.18) and 0.2 (95% CI: 0.05, 0.34) calls per month for concomitant opioid and benzodiazepine and single opioid exposures, respectively, following guideline release.
The guideline release appeared to have a variable association with exposures to single opioid, single benzodiazepines, and concomitant opioid and benzodiazepine cases reported to California Poison Control System. Although exposures to opioids or benzodiazepines alone significantly decreased after guideline release, there was no significant change in concomitant exposures. Additionally, for exposures associated with serious medical outcomes, concomitant exposures, and single opioid exposures significantly increased following guideline release.
Our results suggest that the guideline was not associated with a corresponding decrease in the number of concomitant poisoning exposures reported to California Poison Control System. Additional interventions may be needed to reduce concomitant exposures to opioids and benzodiazepines.
2016 年 3 月，美国疾病控制与预防中心发布了《慢性疼痛阿片类药物处方指南》，旨在为初级保健临床医生提供指导。其中一条建议是反对同时开具阿片类药物和苯二氮䓬类药物的处方。尽管现有研究表明，指南发布后，临床医生减少了这两类药物的联合处方，但关于其对患者医疗结果（如过量用药）可能产生的影响，数据有限。
本回顾性观察性研究分析了 2012 年 1 月至 2021 年 6 月向加利福尼亚毒物控制中心报告的阿片类药物和苯二氮䓬类药物单独或联合暴露的情况。中断时间序列分析确定了指南发布前后每月呼叫量的差异。对于导致严重医疗后果的暴露情况，还进行了额外的分析，以评估趋势并确定相关变量。
加利福尼亚毒物控制中心报告的同时使用阿片类药物和苯二氮䓬类药物的暴露情况在指南发布前后没有显著变化。与指南发布前相比，指南发布后，单一阿片类药物或单一苯二氮䓬类药物的暴露量每月分别显著减少 1.07（95%置信区间：-1.62，-0.51）和 1.82（95%置信区间：-2.33，-1.31）个电话。对于与严重医疗后果相关的暴露电话，同时使用阿片类药物和苯二氮䓬类药物以及单一阿片类药物的暴露量每月分别显著增加 0.11（95%置信区间：0.04，0.18）和 0.2（95%置信区间：0.05，0.34）个电话。
该指南的发布似乎与加利福尼亚毒物控制中心报告的单一阿片类药物、单一苯二氮䓬类药物和同时使用阿片类药物和苯二氮䓬类药物的暴露情况之间存在不确定的关联。尽管指南发布后，单独使用阿片类药物或苯二氮䓬类药物的暴露量显著减少，但同时使用的暴露量没有显著变化。此外，对于与严重医疗后果相关的暴露情况，同时使用阿片类药物和苯二氮䓬类药物以及单一阿片类药物的暴露量显著增加。
我们的研究结果表明，该指南的发布并没有导致加利福尼亚毒物控制中心报告的同时使用阿片类药物和苯二氮䓬类药物的暴露数量相应减少。可能需要采取额外的干预措施来减少同时使用阿片类药物和苯二氮䓬类药物的暴露。
