关于阿片类药物处方初始特征对阿片类药物新患者长期使用阿片类药物的影响的最新观点。

IF 3.9 2区医学 Q1 PSYCHIATRY

Drug and alcohol dependence Pub Date : 2024-10-24 DOI:10.1016/j.drugalcdep.2024.112463

Allen M. Smith , Anuj Shah , Bradley C. Martin

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引用次数: 0

摘要

研究目的这项回顾性队列研究利用代表美国商业保险患者的 IQVIA PharMetrics®Plus for Academics 数据库，对长期使用阿片类药物（LTOU）的可能性与阿片类药物初始处方特征（剂量、阿片类药物类型）和阿片类药物初始处方发作（供应天数）之间的关系提供了最新观点：采用 Kaplan-Meier 估计值确定阿片类药物在 365 天内继续使用的可能性，并根据初始阿片类药物处方和初始阿片类药物处方发作的特征进行分层。对 Cox 比例危险模型进行估计，以确定初始阿片类药物处方特征与阿片类药物持续使用之间的关联强度：共确定了 578,403 名无癌症、无 SUD、年龄≥14 岁、在 2016 年 4 月 13 日至 2020 年 4 月 18 日期间开具过≥1 次阿片类药物处方的受试者，并根据停用阿片类药物的时间进行了分类。在考虑删减因素后，5.05% 的人继续使用阿片类药物的时间≥365 天。与 1-2 天的供应量（DS）相比，DS 越高，停止使用阿片类药物的可能性越低[HRs (CIs)：3-4 天用量 = 0.66 (0.65-0.66)；5-7 天用量 = 0.41 (0.41-0.41)；8-10 天用量 = 0.33 (0.33-0.34)；11-14 天用量 = 0.30 (0.29-0.31)；15-21 天用量 = 0.26 (0.26-0.27)；≥22 天用量 = 0.17 (0.17-0.18)]。在不同的疼痛病因中，DS增加与停用阿片类药物可能性降低之间的关系仍然一致：结论：在阿片类药物处方更加保守的时代，DS的增加仍然是与LTOU可能性增加相关的最强因素。

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An updated view on the influence of initial opioid prescription characteristics on long-term opioid use among opioid naïve patients

Objectives

This retrospective cohort study provides an updated view on the association between the likelihood of long-term opioid use (LTOU) and characteristics of the initial opioid prescription (dose, opioid type) and initial opioid prescription episode (days’ supplied) among opioid-naïve patients utilizing IQVIA PharMetrics®Plus for Academics database representative of commercially insured patients in the US.

Methods

Kaplan-Meier estimates were used to determine opioid continuation likelihood at 365 days stratified by the characteristics of the initial opioid prescription and initial opioid prescription episode. Cox-proportional hazard models were estimated to determine the strength of association between initial opioid prescription characteristics and opioid continuation.

Results

A total of 578,403 cancer-free, SUD-free, opioid-naïve subjects aged ≥14 years that filled ≥1 opioid prescriptions between April 13, 2016 and April 18, 2020 were identified and categorized based on time to opioid discontinuation. After accounting for censoring, 5.05 % of persons continued opioid use for ≥365 days. Compared to a 1–2 days’ supply (DS), the likelihood of opioid discontinuation was consistently lower with higher DS [HRs (CIs): 3–4 days' supply = 0.66 (0.65–0.66); 5–7 DS = 0.41 (0.41–0.41); 8–10 DS = 0.33 (0.33–0.34); 11–14 DS = 0.30 (0.29–0.31); 15–21 DS = 0.26 (0.26–0.27); ≥22 DS = 0.17 (0.17–0.18)]. These associations between increased DS and decreased likelihood of discontinuing opioid remained consistent across different pain etiologies.

Conclusions

In this era of more conservative opioid prescribing, increases in DS remains the strongest factor associated with a higher likelihood of LTOU.

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来源期刊

Drug and alcohol dependence 医学-精神病学

CiteScore

7.40

自引率

7.10%

发文量

409

审稿时长

41 days

期刊介绍： Drug and Alcohol Dependence is an international journal devoted to publishing original research, scholarly reviews, commentaries, and policy analyses in the area of drug, alcohol and tobacco use and dependence. Articles range from studies of the chemistry of substances of abuse, their actions at molecular and cellular sites, in vitro and in vivo investigations of their biochemical, pharmacological and behavioural actions, laboratory-based and clinical research in humans, substance abuse treatment and prevention research, and studies employing methods from epidemiology, sociology, and economics.