小柯机器人

美国退伍军人事务部Elizabeth M Oliva研究团队近日取得一项新成果。他们的最新研究分析了美国退伍军人停用阿片类药物处方、阿片类药物治疗时间与用药过量或自杀死亡的相关性。2020年3月4日，《英国医学杂志》发表了这一成果。

为了评估退伍军人卫生管理局停止使用阿片类药物治疗、治疗时间长短、以及因服用过量或自杀而死之间的关联，研究组进行了一项观察研究。

2013财年开始至2014财年结束（2012年10月1日至2014年9月30日），退伍军人卫生管理局中有1394102名患者使用了阿片类镇痛剂的门诊处方。

共有2887人因药物过量或自杀而死亡。阿片类药物停止治疗的发生率为57.4％，基于阿片类药物治疗时间的长短，分别为32.0％（≤30天）、8.7％（31-90天）、22.7％（91-400天） 、36.6％（> 400天）。

阿片类药物停止治疗与治疗时间之间的相互作用显著；不论治疗时间长短，停止治疗都会导致因用药过量或自杀而死的风险增加，且随着治疗时间的延长，这种风险逐渐增大。

停用阿片类药物治疗的患者的风险比为1.67（≤30天）、2.80（31-90天）、3.95（91-400天）和6.77（> 400天）。描述性生命表数据表明，开始或停止使用阿片类药物治疗后，服用过量或自杀的死亡率迅速增加，但在约3-12个月内有所下降。

总之，在停止阿片类药物治疗后，患者因服用过量或自杀而死的风险增大，而在停止使用阿片类药物治疗之前，接受治疗的时间越长，风险越大。描述性数据表明，开始使用阿片类药物也是一个危险时期。

阿片类药物的安全处方应从患者的角度进行更充分的考虑，并从患者角度降低风险。在开始和停止阿片类药物治疗后，尤其是在前三个月内，应格外注意防范患者服用过量或自杀的风险。

附：英文原文

Title: Associations between stopping prescriptions for opioids, length of opioid treatment, and overdose or suicide deaths in US veterans: observational evaluation

Author: Elizabeth M Oliva, Thomas Bowe, Ajay Manhapra, Stefan Kertesz, Jennifer M Hah, Patricia Henderson, Amy Robinson, Meenah Paik, Friedhelm Sandbrink, Adam J Gordon, Jodie A Trafton

Issue&Volume: 2020/03/04

Abstract: AbstractObjective To examine the associations between stopping treatment with opioids, length of treatment, and death from overdose or suicide in the Veterans Health Administration.Design Observational evaluation.Setting Veterans Health Administration.Participants 1394102 patients in the Veterans Health Administration with an outpatient prescription for an opioid analgesic from fiscal year 2013 to the end of fiscal year 2014 (1 October 2012 to 30 September 2014).Main outcome measures A multivariable Cox non-proportional hazards regression model examined death from overdose or suicide, with the interaction of time varying opioid cessation by length of treatment (≤30, 31-90, 91-400, and >400 days) as the main covariates. Stopping treatment with opioids was measured as the time when a patient was estimated to have no prescription for opioids, up to the end of the next fiscal year (2014) or the patient’s death.Results 2887 deaths from overdose or suicide were found. The incidence of stopping opioid treatment was 57.4% (n=799668) overall, and based on length of opioid treatment was 32.0% (≤30 days), 8.7% (31-90 days), 22.7% (91-400 days), and 36.6% (>400 days). The interaction between stopping treatment with opioids and length of treatment was significant (P400 days). Descriptive life table data suggested that death rates for overdose or suicide increased immediately after starting or stopping treatment with opioids, with the incidence decreasing over about three to 12 months.Conclusions Patients were at greater risk of death from overdose or suicide after stopping opioid treatment, with an increase in the risk the longer patients had been treated before stopping. Descriptive data suggested that starting treatment with opioids was also a risk period. Strategies to mitigate the risk in these periods are not currently a focus of guidelines for long term use of opioids. The associations observed cannot be assumed to be causal; the context in which opioid prescriptions were started and stopped might contribute to risk and was not investigated. Safer prescribing of opioids should take a broader view on patient safety and mitigate the risk from the patient’s perspective. Factors to address are those that place patients at risk for overdose or suicide after beginning and stopping opioid treatment, especially in the first three months.

DOI: 10.1136/bmj.m283

Source: https://www.bmj.com/content/368/bmj.m283

BMJ-British Medical Journal:《英国医学杂志》，创刊于1840年。隶属于BMJ出版集团，最新IF：93.333
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