Verena E. Metz PhD , Vanessa A. Palzes MPH , Ingrid A. Binswanger MD , Andrea Altschuler PhD , Melissa N. Poulsen PhD , Brian K. Ahmedani PhD , Susan E. Andrade ScD , Robin E. Clark PhD , Rulin C. Hechter MD , Michael A. Horberg MD , Katherine Sanchez PhD , Steffani R. Bailey PhD , Kari A. Stephens PhD , Andrea L. Rubinstein MD , Cynthia I. Campbell PhD
{"title":"减少处方阿片类药物剂量后按性别和年龄划分的不良事件风险。","authors":"Verena E. Metz PhD , Vanessa A. Palzes MPH , Ingrid A. Binswanger MD , Andrea Altschuler PhD , Melissa N. Poulsen PhD , Brian K. Ahmedani PhD , Susan E. Andrade ScD , Robin E. Clark PhD , Rulin C. Hechter MD , Michael A. Horberg MD , Katherine Sanchez PhD , Steffani R. Bailey PhD , Kari A. Stephens PhD , Andrea L. Rubinstein MD , Cynthia I. Campbell PhD","doi":"10.1016/j.amepre.2025.108085","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><div>Prescription opioid dose reductions can raise the risk of adverse events for patients on long-term opioid therapy for noncancer pain. Evidence on whether risks differ by age or sex is needed to support tailored clinical decision-making.</div></div><div><h3>Methods</h3><div>In 2024, a secondary analysis of an observational cohort study was conducted across 8 U.S. healthcare systems analyzing electronic health records and claims data from a prescription opioid registry (excluding buprenorphine prescriptions) between January 1, 2012, and December 31, 2018, including adults with stable prescription opioid use and a subsequent ≥2-month dose reduction period (<em>n</em>=60,040), yielding 600,234 dose reduction periods as the analytic sample.</div><div>Differences in the association between dose reduction level (1% to <15%, 15% to <30%, 30% to <100%, and 100% from baseline) and potential adverse events (emergency department visits, opioid overdose, all-cause mortality, and benzodiazepine prescription fills) in the month after dose reduction by sex and age group were examined by including interaction terms in logistic regression models.</div></div><div><h3>Results</h3><div>Of the 600,234 dose reduction periods, 346,733 were among women, with a mean age of 57.5 (SD=13.2) years for women and 56.7 (SD=12.1) years for men. Associations between dose reduction levels and potential adverse events did not differ significantly by sex, but differed by age for emergency department visits: patients aged 40–64 and ≥65 years with dose reductions of 30% to <100% had lower odds than those aged 19–39 years (adjusted ratio of OR=0.87, CI=0.80, 0.96; adjusted ratio of OR=0.82, CI=0.74, 0.91, respectively).</div></div><div><h3>Conclusions</h3><div>Patients aged <40 years may benefit from closer monitoring in the month after dose reduction, given their higher odds of an emergency department visit.</div></div>","PeriodicalId":50805,"journal":{"name":"American Journal of Preventive Medicine","volume":"69 6","pages":"Article 108085"},"PeriodicalIF":4.5000,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Risks for Adverse Events by Sex and Age After Prescription Opioid Dose Reduction\",\"authors\":\"Verena E. Metz PhD , Vanessa A. Palzes MPH , Ingrid A. Binswanger MD , Andrea Altschuler PhD , Melissa N. Poulsen PhD , Brian K. Ahmedani PhD , Susan E. Andrade ScD , Robin E. Clark PhD , Rulin C. Hechter MD , Michael A. Horberg MD , Katherine Sanchez PhD , Steffani R. Bailey PhD , Kari A. Stephens PhD , Andrea L. Rubinstein MD , Cynthia I. Campbell PhD\",\"doi\":\"10.1016/j.amepre.2025.108085\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Introduction</h3><div>Prescription opioid dose reductions can raise the risk of adverse events for patients on long-term opioid therapy for noncancer pain. Evidence on whether risks differ by age or sex is needed to support tailored clinical decision-making.</div></div><div><h3>Methods</h3><div>In 2024, a secondary analysis of an observational cohort study was conducted across 8 U.S. healthcare systems analyzing electronic health records and claims data from a prescription opioid registry (excluding buprenorphine prescriptions) between January 1, 2012, and December 31, 2018, including adults with stable prescription opioid use and a subsequent ≥2-month dose reduction period (<em>n</em>=60,040), yielding 600,234 dose reduction periods as the analytic sample.</div><div>Differences in the association between dose reduction level (1% to <15%, 15% to <30%, 30% to <100%, and 100% from baseline) and potential adverse events (emergency department visits, opioid overdose, all-cause mortality, and benzodiazepine prescription fills) in the month after dose reduction by sex and age group were examined by including interaction terms in logistic regression models.</div></div><div><h3>Results</h3><div>Of the 600,234 dose reduction periods, 346,733 were among women, with a mean age of 57.5 (SD=13.2) years for women and 56.7 (SD=12.1) years for men. Associations between dose reduction levels and potential adverse events did not differ significantly by sex, but differed by age for emergency department visits: patients aged 40–64 and ≥65 years with dose reductions of 30% to <100% had lower odds than those aged 19–39 years (adjusted ratio of OR=0.87, CI=0.80, 0.96; adjusted ratio of OR=0.82, CI=0.74, 0.91, respectively).</div></div><div><h3>Conclusions</h3><div>Patients aged <40 years may benefit from closer monitoring in the month after dose reduction, given their higher odds of an emergency department visit.</div></div>\",\"PeriodicalId\":50805,\"journal\":{\"name\":\"American Journal of Preventive Medicine\",\"volume\":\"69 6\",\"pages\":\"Article 108085\"},\"PeriodicalIF\":4.5000,\"publicationDate\":\"2025-09-06\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"American Journal of Preventive Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0749379725005537\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"MEDICINE, GENERAL & INTERNAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"American Journal of Preventive Medicine","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0749379725005537","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
Risks for Adverse Events by Sex and Age After Prescription Opioid Dose Reduction
Introduction
Prescription opioid dose reductions can raise the risk of adverse events for patients on long-term opioid therapy for noncancer pain. Evidence on whether risks differ by age or sex is needed to support tailored clinical decision-making.
Methods
In 2024, a secondary analysis of an observational cohort study was conducted across 8 U.S. healthcare systems analyzing electronic health records and claims data from a prescription opioid registry (excluding buprenorphine prescriptions) between January 1, 2012, and December 31, 2018, including adults with stable prescription opioid use and a subsequent ≥2-month dose reduction period (n=60,040), yielding 600,234 dose reduction periods as the analytic sample.
Differences in the association between dose reduction level (1% to <15%, 15% to <30%, 30% to <100%, and 100% from baseline) and potential adverse events (emergency department visits, opioid overdose, all-cause mortality, and benzodiazepine prescription fills) in the month after dose reduction by sex and age group were examined by including interaction terms in logistic regression models.
Results
Of the 600,234 dose reduction periods, 346,733 were among women, with a mean age of 57.5 (SD=13.2) years for women and 56.7 (SD=12.1) years for men. Associations between dose reduction levels and potential adverse events did not differ significantly by sex, but differed by age for emergency department visits: patients aged 40–64 and ≥65 years with dose reductions of 30% to <100% had lower odds than those aged 19–39 years (adjusted ratio of OR=0.87, CI=0.80, 0.96; adjusted ratio of OR=0.82, CI=0.74, 0.91, respectively).
Conclusions
Patients aged <40 years may benefit from closer monitoring in the month after dose reduction, given their higher odds of an emergency department visit.
期刊介绍:
The American Journal of Preventive Medicine is the official journal of the American College of Preventive Medicine and the Association for Prevention Teaching and Research. It publishes articles in the areas of prevention research, teaching, practice and policy. Original research is published on interventions aimed at the prevention of chronic and acute disease and the promotion of individual and community health.
Of particular emphasis are papers that address the primary and secondary prevention of important clinical, behavioral and public health issues such as injury and violence, infectious disease, women''s health, smoking, sedentary behaviors and physical activity, nutrition, diabetes, obesity, and substance use disorders. Papers also address educational initiatives aimed at improving the ability of health professionals to provide effective clinical prevention and public health services. Papers on health services research pertinent to prevention and public health are also published. The journal also publishes official policy statements from the two co-sponsoring organizations, review articles, media reviews, and editorials. Finally, the journal periodically publishes supplements and special theme issues devoted to areas of current interest to the prevention community.