阿片类药物处方连续性与老年人阿片类药物使用障碍风险的关系

IF 3.6 2区医学 Q1 PSYCHIATRY

Drug and alcohol dependence Pub Date : 2025-09-19 DOI:10.1016/j.drugalcdep.2025.112899

Prachi Prajapati , Shadi Bazzazzadehgan , Yi Yang , Kaustuv Bhattacharya , Shishir Maharjan , John P. Bentley , Sujith Ramachandran

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引用次数: 0

摘要

背景：较低的阿片类药物处方连续性与阿片类药物相关不良事件的高风险相关。本研究旨在评估阿片类药物处方连续性与阿片类药物使用障碍（OUD）风险之间的关系。方法选取2012年至2020年接受长期阿片类药物治疗（LTOT）的成人（≥65岁），占医保索赔数据的5%。研究结果为OUD。使用护理连续性指数（COCI）测量阿片类药物处方连续性，作为从LTOT开始到结果/审查每月测量的时变预测因子。使用扩展Cox回归模型评估COCI与OUD风险之间的关联。结果153,570例患者中，7.61% （n = 11,697）在LTOT开始后发生OUD。平均（SD）年龄为75.74（8.42）岁，70.16% （n = 107,743）为女性。校正协变量后，中度COCI患者(校正风险比[aHR] = 1.76, 95% CI 1.58 - 1.96; p <；001)和高COCI (aHR = 1.32, 95% CI 1.22 - 1.44; p <；001)与COCI低的患者相比，有更高的OUD风险。高COCI患者（aHR = 0.75, 95% CI 0.69 - 0.82; p <）001)的患者发生OUD的风险明显低于COCI为中等的患者。结论更大的阿片类药物处方连续性可能会促进OUD的发现，强调一致性护理对更好地管理阿片类药物相关疾病的重要性。另外，在LTOT患者中，高度分散的护理可能导致较低的OUD检出率，尽管患者可能具有较高的OUD风险。因此，建立信任的医患关系对于早期发现和管理OUD非常重要。

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The association of opioid prescribing continuity and the risk of opioid use disorder among older adults

Background

Lower opioid prescribing continuity is associated with a higher risk of opioid-related adverse events. This study aimed to evaluate the association between opioid prescribing continuity and risk of opioid use disorder (OUD).

Methods

Older adults (≥ 65 years) on long-term opioid therapy (LTOT) were identified from 2012 to 2020 5 % Medicare claims data. The study outcome was OUD. Opioid prescribing continuity, measured using the continuity of care index (COCI), was treated as a time-varying predictor measured monthly from LTOT initiation until outcome/censoring. The association between COCI and risk of OUD was evaluated using an extended Cox regression model.

Results

Of 153,570 patients, 7.61 % (n = 11,697) developed OUD after LTOT initiation. The mean (SD) age was 75.74 (8.42) years and 70.16 % (n = 107,743) were female. After adjusting for covariates, patients with medium COCI (adjusted hazard ratio [aHR] = 1.76, 95 % CI 1.58 – 1.96; p < .001) and high COCI (aHR = 1.32, 95 % CI 1.22 – 1.44; p < .001) had higher OUD risk compared to those with low COCI. Patients with high COCI (aHR = 0.75, 95 % CI 0.69 – 0.82; p < .001) had significantly lower hazard of OUD than those with medium COCI.

Conclusion

Greater opioid prescribing continuity may promote OUD detection, highlighting the importance of consistent care for better management of opioid-related conditions. Alternatively, highly fragmented care among patients with LTOT may lead to lower detection of OUD, despite patients potentially being at higher risk for OUD. Thus, it is important to build trustful patient-prescriber relationships for early OUD detection and management.

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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.