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Asociación de disminución de dosis con sobredosis o crisis de salud mental entre pacientes a los que se les recetaron

Alicia Agnoli^1,2, Guibo Xing², Daniel J Tancredi^2,3

¹Department of Family and Community Medicine, University of California, Davis, Sacramento.

|August 3, 2021

Resumen

La disminución gradual de la dosis de opiáceos en pacientes en tratamiento a largo plazo se relacionó con mayores tasas de sobredosis y crisis de salud mental. Estos hallazgos ponen de relieve los riesgos potenciales asociados con la reducción de las dosis de opiáceos, haciendo hincapié en la necesidad de un manejo cuidadoso de los pacientes.

Área de la Ciencia:

Tratamiento del dolor
Salud pública
Farmacología clínica

Sus antecedentes:

Las directrices nacionales y la mortalidad relacionada con los opiáceos han provocado una disminución gradual de la dosis en los pacientes tratados con opiáceos a largo plazo.
Existen datos limitados sobre los riesgos de la disminución gradual de las dosis de opioides, incluidas las crisis de sobredosis y de salud mental.

Objetivo del estudio:

Investigar la asociación entre la disminución gradual de la dosis de opiáceos y la incidencia de sobredosis y crisis de salud mental en pacientes en tratamiento estable y a largo plazo con dosis más altas de opiáceos.

Principales métodos:

Estudio de cohorte retrospectivo en el que se utilizaron datos de alegaciones médicas y farmacéuticas no identificadas (2008-2019).
Se incluyeron adultos con prescripciones estables de dosis más altas de opioides (≥50 MME/día) durante al menos 12 meses.
La disminución gradual de los opiáceos se define como una reducción de la dosis relativa de ≥15% en ventanas de 60 días; los resultados se evaluaron mediante modelos de regresión.

Principales resultados:

La disminución gradual de los opiáceos se asoció con un aumento significativo de la tasa de sobredosis (RIA, 1,68) y crisis de salud mental (RIA, 2,28).
La velocidad más rápida de reducción de la dosis se correlacionó con mayores riesgos de sobredosis y crisis de salud mental.
El estudio analizó 203.920 períodos de referencia estables en 113.618 pacientes.

Conclusiones:

La disminución gradual de la dosis de opiáceos en pacientes tratados a largo plazo con dosis más altas se asocia significativamente con un mayor riesgo de sobredosis y crisis de salud mental.
Los hallazgos sugieren posibles daños de la reducción progresiva, lo que justifica una cuidadosa consideración en la práctica clínica.
La interpretación está limitada por la naturaleza observacional del diseño del estudio.

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