Early High-Risk Opioid Prescribing and Persistent Opioid Use in Australian Workers with Workers' Compensation Claims for Back and Neck Musculoskeletal Disorders or Injuries: A Retrospective Cohort Study.
Yonas Getaye Tefera, Shannon Gray, Suzanne Nielsen, Michael Di Donato, Alex Collie
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引用次数: 0
Abstract
Background: Opioid prescribing to injured workers has increased despite evidence demonstrating that risks often outweigh the benefits. High-risk prescribing and persistent opioid use are often associated with harm. However, there are limited data on what predicts early high-risk and persistent opioid prescribing in Australian workers with back and neck-related injuries or disorders.
Objective: The purpose of this study was to determine the prevalence and identify determinants of early high-risk and persistent opioid prescribing in Australian workers with back and neck conditions.
Methods: A retrospective cohort study was carried out with injured workers with workers' compensation claims for back and neck conditions who filled at least one opioid prescription within the first 90 days after injury from 1 January 2010 to 31 December 2019. High-risk opioid prescribing practices in the first 90 days were measured using one of four indicators of risk (high-total opioid volume on first dispensing occasion-exceeding 350 mg oral morphine equivalent in the first week, average high-dose over 90 days-higher than 50 mg oral morphine equivalent, early supply with long-acting opioids, and concurrent psychotropic prescriptions). Persistent opioid use was determined using group-based trajectory modeling over the subsequent 1-year. Multivariable logistic regression was used to identify predictors of high-risk opioid prescribing in the first 90 days and persistent opioid use in the subsequent year.
Results: A total of 6278 injured workers prescribed opioids were included. At least one indicator of high-risk opioid prescribing was identified in 67.1% of the sample in the first 3 months. Persistent opioid use was identified in 22.8% of the sample over the subsequent year. Early high-risk opioid prescribing was associated with double the odds of persistent use (aOR 2.19, 95% CI 1.89-2.53). Injured workers residing in rural areas (inner regional and outer regional/remote Australia) had higher odds of high-risk prescribing (aOR 1.26, 95% CI 1.11-1.44) and (aOR 1.43, 95% CI 1.10-1.87), respectively, compared with those in major cities. Similarly, workers residing in areas with most disadvantaged and advantaged socioeconomic quintile had higher (aOR 1.18, 95% CI 1.01-1.39) and lower (aOR 0.68, 95% CI 0.56-0.82) odds of persistent opioid use, respectively, compared with those in the middle socioeconomic quintiles.
Conclusions: A total of two-thirds of injured workers receiving opioids in the first 90 days show evidence of high-risk prescribing, with nearly one-quarter exhibiting persistent opioid use over the subsequent year. Early high-risk opioid prescribing doubles the odds of opioid persistence. There is a need for further research and careful scrutiny of opioid prescribing in this population.
背景：尽管有证据表明风险往往大于收益，但对受伤工人开具的阿片类药物处方有所增加。高风险处方和持续使用阿片类药物往往与危害有关。然而，在澳大利亚背部和颈部相关损伤或疾病的工人中，预测早期高风险和持续性阿片类药物处方的数据有限。目的：本研究的目的是确定澳大利亚背部和颈部疾病工人早期高危和持续阿片类药物处方的患病率和决定因素。方法：对2010年1月1日至2019年12月31日受伤后90天内至少服用过一次阿片类药物处方的背部和颈部疾病工伤索赔工人进行回顾性队列研究。使用四个风险指标中的一个来衡量前90天的高风险阿片类药物处方做法（第一次配药时的高总阿片类药物量-第一周超过350毫克口服吗啡当量，90天以上的平均高剂量-高于50毫克口服吗啡当量，早期供应长效阿片类药物，以及同时开具精神药物处方）。在随后的1年中，使用基于组的轨迹模型确定阿片类药物的持续使用。使用多变量logistic回归来确定前90天高危阿片类药物处方和随后一年持续使用阿片类药物的预测因素。结果：共纳入使用阿片类药物的工伤工人6278例。在前3个月，67.1%的样本中至少确定了一个高危阿片类药物处方指标。在随后的一年里，22.8%的样本中发现持续使用阿片类药物。早期高危阿片类药物处方与持续使用几率加倍相关（aOR 2.19, 95% CI 1.89-2.53）。与主要城市相比，居住在农村地区（澳大利亚内陆地区和外地区/偏远地区）的受伤工人分别具有更高的高风险处方几率（aOR 1.26, 95% CI 1.11-1.44）和（aOR 1.43, 95% CI 1.10-1.87）。同样，居住在最不利和最有利的社会经济五分位数地区的工人与中等社会经济五分位数的工人相比，分别具有较高（aOR 1.18, 95% CI 1.01-1.39）和较低（aOR 0.68, 95% CI 0.56-0.82）的持续阿片类药物使用几率。结论：在头90天接受阿片类药物治疗的受伤工人中，有三分之二的人有高风险处方的证据，近四分之一的人在随后的一年中持续使用阿片类药物。早期高风险阿片类药物处方使阿片类药物持续存在的几率增加了一倍。有必要对这一人群的阿片类药物处方进行进一步研究和仔细审查。
期刊介绍：
CNS Drugs promotes rational pharmacotherapy within the disciplines of clinical psychiatry and neurology. The Journal includes:
- Overviews of contentious or emerging issues.
- Comprehensive narrative reviews that provide an authoritative source of information on pharmacological approaches to managing neurological and psychiatric illnesses.
- Systematic reviews that collate empirical evidence to answer a specific research question, using explicit, systematic methods as outlined by the PRISMA statement.
- Adis Drug Reviews of the properties and place in therapy of both newer and established drugs in neurology and psychiatry.
- Original research articles reporting the results of well-designed studies with a strong link to clinical practice, such as clinical pharmacodynamic and pharmacokinetic studies, clinical trials, meta-analyses, outcomes research, and pharmacoeconomic and pharmacoepidemiological studies.
Additional digital features (including animated abstracts, video abstracts, slide decks, audio slides, instructional videos, infographics, podcasts and animations) can be published with articles; these are designed to increase the visibility, readership and educational value of the journal’s content. In addition, articles published in CNS Drugs may be accompanied by plain language summaries to assist readers who have some knowledge of, but not in-depth expertise in, the area to understand important medical advances.
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