美沙酮类药物使用障碍药物与 Medicaid 中阿片类药物重复过量风险降低的关联：一项队列研究。
Association of medications for opioid use disorder with reduced risk of repeat opioid overdose in Medicaid: A cohort study.
机构信息
Missouri Institute of Mental Health, University of Missouri - St. Louis, 1 University Blvd, St. Louis, MO 63121, USA.
Center for Health Services Research, Institute for Health, Rutgers University, 112 Paterson Street, New Brunswick, NJ 08901, USA.
出版信息
J Subst Use Addict Treat. 2024 Feb;157:209218. doi: 10.1016/j.josat.2023.209218. Epub 2023 Nov 19.
INTRODUCTION
Following a nonfatal opioid overdose, patients are at high risk for repeat overdose. The objective of this study was to examine the association of MOUD after nonfatal opioid overdose with risk of repeat overdose in the following year.
METHODS
This retrospective cohort study analyzed Missouri Medicaid claims from July 2012 to December 2021. The study identified opioid overdoses occurring between 2013 and 2020 using diagnosis codes for opioid poisoning in an inpatient or emergency department setting. The study implemented Cox models with a time-varying covariate for post-overdose receipt of MOUD.
RESULTS
During the study period, MOUD receipt after overdose more than tripled, from 4.8 % to 18.9 %. Overall, only 12.1 % of patients received MOUD in the year after index. MOUD during follow-up was associated with significantly lower risk of repeat overdose (HR = 0.34, 95 % CI = 0.14-0.82). Out of 3017 individuals meeting inclusion criteria, 13.6 % had a repeat opioid overdose within 1 year. Repeat overdose risk was higher for those whose index overdose involved heroin or synthetic opioids (HR = 1.71, 95 % CI = 1.35-2.15), but MOUD was associated with significantly reduced risk in this group (HR = 0.34, 95 % CI = 0.13-0.92).
CONCLUSIONS
MOUD receipt was associated with reduced risk of repeat overdose. Those whose index overdoses involved heroin or synthetic opioids were at greater risk of repeat overdose, but MOUD was associated with reduced risk in this group.
简介
非致死性阿片类药物过量后，患者有很高的再次过量的风险。本研究的目的是研究非致死性阿片类药物过量后接受药物维持治疗（MOUD）与下一年再次过量的风险之间的关系。
方法
本回顾性队列研究分析了 2012 年 7 月至 2021 年 12 月期间密苏里州医疗补助计划的索赔数据。该研究使用住院或急诊科阿片类药物中毒的诊断代码，在 2013 年至 2020 年期间确定了阿片类药物过量事件。该研究实施了 Cox 模型，其中包含一个时间变化的协变量，用于记录阿片类药物过量后接受 MOUD 的情况。
结果
在研究期间，阿片类药物过量后接受 MOUD 的比例增加了两倍多，从 4.8%增加到 18.9%。总体而言，只有 12.1%的患者在指数后一年接受 MOUD。在随访期间接受 MOUD 与重复过量的风险显著降低相关（HR=0.34，95%CI=0.14-0.82）。在符合纳入标准的 3017 人中，有 13.6%的人在 1 年内再次发生阿片类药物过量。对于那些指数阿片类药物过量涉及海洛因或合成阿片类药物的患者，重复过量的风险更高（HR=1.71，95%CI=1.35-2.15），但 MOUD 与该组的风险显著降低相关（HR=0.34，95%CI=0.13-0.92）。
结论
接受 MOUD 与降低重复过量的风险相关。那些指数阿片类药物过量涉及海洛因或合成阿片类药物的患者，重复过量的风险更高，但 MOUD 与该组的风险降低相关。
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