Long-Term Opioid Therapy and Risk of Opioid Overdose by Derived Clinical Indication in North Carolina, 2006-2018.

IF 2.4 4区医学 Q3 PHARMACOLOGY & PHARMACY

Pharmacoepidemiology and Drug Safety Pub Date : 2025-01-01 DOI:10.1002/pds.70090

Bethany L DiPrete, Shabbar I Ranapurwala, Audrey E Pettifor, Kimberly A Powers, Paul L Delamater, Naoko Fulcher, Brian W Pence

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引用次数: 0

Abstract

Purpose: Long-term opioid therapy (LTOT) has been shown to be associated with opioid overdose, but the definition of LTOT varies widely across studies. We use a rigorous LTOT definition to examine risk of opioid overdose by duration of treatment.

Methods: Data were from a large private health insurance provider in North Carolina linked to mortality records from 2006-2018. Eligible patients were adults (18-64) newly initiating opioid therapy after a pain diagnosis or surgery. We defined LTOT as ≥ 1 opioid prescription per month totaling ≥ 60 days' supply within 90 days. We used inverse probability (IP)-weighted cumulative incidence functions to estimate three-year risk of opioid overdose and IP-weighted Fine-Gray models to estimate sub-distribution hazard ratios, comparing LTOT to short- to medium-term opioid therapy (SMTOT). We also examined modification by derived indication of acute pain or surgery versus chronic pain.

Results: We identified 491 369 patients, and 1.7% were exposed to LTOT. The three-year risk of opioid overdose was 0.3 percentage points (RD_w = 0.003, 95% CI: 0.001, 0.005) higher in LTOT patients compared to patients with SMTOT. The weighted hazard of opioid overdose was 4.4 times as high (HR_w 4.42, 95% CI 2.41, 8.11) among patients exposed to LTOT versus SMTOT. We did not find meaningful modification by clinical indication for opioid therapy.

Conclusions: Exposure to LTOT was associated with increased risk of opioid overdose in this population of privately insured patients using a rigorous definition of LTOT. These findings confirm the importance of guidelines to minimize duration of opioid therapy whenever possible.

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北卡罗莱纳州长期阿片类药物治疗和阿片类药物过量风险的衍生临床适应症，2006-2018。

目的：长期阿片类药物治疗（LTOT）已被证明与阿片类药物过量有关，但LTOT的定义在不同的研究中差异很大。我们使用严格的LTOT定义来检查阿片类药物过量治疗持续时间的风险。方法：数据来自北卡罗来纳州一家大型私人医疗保险提供商，与2006-2018年的死亡率记录相关。符合条件的患者是在疼痛诊断或手术后新开始阿片类药物治疗的成年人（18-64岁）。我们将LTOT定义为每月≥1个阿片类药物处方，在90天内总计≥60天的供应。我们使用逆概率（IP）加权累积发生率函数来估计阿片类药物过量的三年风险，并使用IP加权细灰模型来估计亚分布风险比，将LTOT与中短期阿片类药物治疗（SMTOT）进行比较。我们还检查了急性疼痛或手术与慢性疼痛的衍生指征的改变。结果：我们确定了49369例患者，其中1.7%暴露于LTOT。与SMTOT患者相比，LTOT患者三年阿片类药物过量的风险高0.3个百分点（RDw = 0.003, 95% CI: 0.001, 0.005）。阿片类药物过量的加权危险度（HRw 4.42, 95% CI 2.41, 8.11）是暴露于LTOT和SMTOT的患者的4.4倍。我们没有发现阿片类药物治疗的临床适应症有意义的改变。结论：在使用严格的LTOT定义的私人保险患者人群中，暴露于LTOT与阿片类药物过量风险增加有关。这些发现证实了指南在尽可能缩短阿片类药物治疗持续时间的重要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pharmacoepidemiology and Drug Safety 医学-药学

CiteScore

4.80

自引率

7.70%

发文量

173

审稿时长

3 months

期刊介绍： The aim of Pharmacoepidemiology and Drug Safety is to provide an international forum for the communication and evaluation of data, methods and opinion in the discipline of pharmacoepidemiology. The Journal publishes peer-reviewed reports of original research, invited reviews and a variety of guest editorials and commentaries embracing scientific, medical, statistical, legal and economic aspects of pharmacoepidemiology and post-marketing surveillance of drug safety. Appropriate material in these categories may also be considered for publication as a Brief Report. Particular areas of interest include: design, analysis, results, and interpretation of studies looking at the benefit or safety of specific pharmaceuticals, biologics, or medical devices, including studies in pharmacovigilance, postmarketing surveillance, pharmacoeconomics, patient safety, molecular pharmacoepidemiology, or any other study within the broad field of pharmacoepidemiology; comparative effectiveness research relating to pharmaceuticals, biologics, and medical devices. Comparative effectiveness research is the generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat, and monitor a clinical condition, as these methods are truly used in the real world; methodologic contributions of relevance to pharmacoepidemiology, whether original contributions, reviews of existing methods, or tutorials for how to apply the methods of pharmacoepidemiology; assessments of harm versus benefit in drug therapy; patterns of drug utilization; relationships between pharmacoepidemiology and the formulation and interpretation of regulatory guidelines; evaluations of risk management plans and programmes relating to pharmaceuticals, biologics and medical devices.