处方阿片类药物剂量减少和潜在的不良事件:在美国多个卫生系统的多站点观察队列研究
Verena E Metz1, G Thomas Ray2, Vanessa Palzes2
1Kaiser Permanente Northern California, Division of Research, Center for Addiction and Mental Health Research, Oakland, CA, USA. verena.e.metz@kp.org.
Journal of general internal medicine
|November 6, 2023
概括
美国的阿片类药物剂量减少与不良事件有关. 较大的减少 (30-100%) 增加了急诊室访问,过量服用和死亡的风险,而较小的减少 (15-30%) 增加了急诊室访问的几率.
科学领域:
- 药理学和毒理学 药理学和毒理学
- 公共卫生 公共卫生
- 医疗保健服务研究 医疗服务研究
背景情况:
- 由于阿片类药物危机,美国阿片类药物处方减少.
- 担心阿片类药物剂量降低可能导致不良事件.
研究的目的:
- 检查阿片类药物剂量降低与1个月不良事件风险之间的关联.
- 调查了急诊室的访问,阿片类药物过量服用,二甲处方填充和全因死亡率.
主要方法:
- 使用电子健康记录和来自美国八个卫生系统的索赔数据的观察性队列研究.
- 包括60,040名非癌症患者,至少有一个为期2个月的阿片类药物剂量减少期.
- 使用逻辑回归分析了剂量减少水平 (1-<15%,15-<30%,30-<100%,100%) 和随后的1个月不良事件.
主要成果:
- 剂量减少30-<100%与更高的紧急诊所访问几率 (OR1.14) 相关,阿片类药物过量 (OR 1.41) 和全因死亡率 (OR 1.39).
- 这些较大的减少也与较低的二胺填充率 (OR 0.83) 有关.
- 减少15-<30%增加了急诊室访问几率 (OR 1.08) 和降低了二胺填充几率 (OR 0.93),但没有显示过量或死亡率的关联.
结论:
- 显著降低阿片类药物剂量可能会增加在改变后一个月出现不良事件的风险.
- 建议对接受阿片类药物剂量减少的患者进行仔细监测.
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