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Asociación entre los patrones de prescripción de opioides y las muertes relacionadas con sobredosis de opioides

Amy S B Bohnert¹, Marcia Valenstein, Matthew J Bair

¹Department of Veterans Affairs, Health Services Research & Development Center of Excellence, Ann Arbor, Michigan, USA. amybohne@med.umich.edu

|April 7, 2011

Resumen

Las dosis más altas de opioides aumentan significativamente el riesgo de sobredosis fatal entre los pacientes a los que se les recetaron estos medicamentos. Este riesgo se eleva en varias afecciones, incluidos el dolor crónico y los trastornos por uso de sustancias.

Área de la Ciencia:

Investigación médica Investigación médica.
Farmacología Farmacología.
Salud Pública La salud pública.

Sus antecedentes:

Las muertes por sobredosis relacionadas con los opioides recetados han aumentado dramáticamente en los Estados Unidos en la última década.
Los patrones de prescripción de opioides pueden influir en el riesgo de mortalidad por sobredosis.

Objetivo del estudio:

Investigar la asociación entre la dosis de opiáceos prescrita y los esquemas de dosificación y el riesgo de sobredosis fatal.
Para analizar esta asociación en grupos de pacientes con cáncer, dolor crónico, dolor agudo y trastornos por uso de sustancias.

Principales métodos:

Se realizó un estudio de caso-cohorte utilizando datos de la Administración de Salud de Veteranos (VHA) entre 2004 y 2008.
Se incluyeron 750 fallecidos por sobredosis no intencional de opioides recetados y 154,684 pacientes que recibían terapia con opioides.
Se analizaron las asociaciones entre los regímenes de opiáceos (dosis, horario) y la muerte por sobredosis, ajustando los factores demográficos y de comorbilidad.

Principales resultados:

La frecuencia general de sobredosis fatales entre los pacientes tratados con opioides fue del 0,04%.
Las dosis diarias máximas de opiáceos prescritas más altas se asociaron directamente con un mayor riesgo de muerte por sobredosis.
Para dosis ≥100 mg/día en comparación con 1-19 mg/día, las proporciones de riesgo ajustadas oscilaron entre 4,54 (trastornos por uso de sustancias) y 11,99 (cáncer).
La combinación de dosificación según sea necesario y regularmente programada no se relacionó con un mayor riesgo de sobredosis.

Conclusiones:

Las dosis más altas de opioides prescritos están vinculadas a un mayor riesgo de sobredosis fatal en pacientes que reciben terapia opioide para el dolor.
Los hallazgos subrayan la importancia de la administración de la dosis para mitigar el riesgo de sobredosis de opioides.

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