Association Between Prescription Opioid Therapy for Noncancer Pain and Hepatitis C Virus Seroconversion.

Autor:	Wilton J; British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada., Wong S; British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada., Purssell R; British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.; Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada., Abdia Y; British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada., Chong M; British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada., Karim ME; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.; Centre for Health Evaluation & Outcome Sciences, St Paul's Hospital Vancouver, British Columbia, Canada., MacInnes A; Pain Management Clinic, Jim Pattison Outpatient Care & Surgical Centre, Fraser Health Authority, Surrey, British Columbia, Canada.; Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada., Bartlett SR; British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.; Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia., Balshaw RF; George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada., Gomes T; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.; Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada.; ICES, Toronto, Ontario, Canada., Yu A; British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada., Alvarez M; British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada., Dart RC; Rocky Mountain Poison and Drug Safety, Denver Health and Hospital Authority, Denver, Colorado.; Department of Emergency Medicine, University of Colorado Health Sciences Center, Denver., Krajden M; British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada., Buxton JA; British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada., Janjua NZ; British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.; Centre for Health Evaluation & Outcome Sciences, St Paul's Hospital Vancouver, British Columbia, Canada.
Jazyk:	angličtina
Zdroj:	JAMA network open [JAMA Netw Open] 2022 Jan 04; Vol. 5 (1), pp. e2143050. Date of Electronic Publication: 2022 Jan 04.
DOI:	10.1001/jamanetworkopen.2021.43050
Abstrakt:	Importance: Initiation of injection drug use may be more frequent among people dispensed prescription opioid therapy for noncancer pain, potentially increasing the risk of hepatitis C virus (HCV) acquisition. Objective: To assess the association between medically dispensed long-term prescription opioid therapy for noncancer pain and HCV seroconversion among individuals who were initially injection drug use-naive. Design, Setting, and Participants: A population-based, retrospective cohort study of individuals tested for HCV in British Columbia, Canada, with linkage to outpatient pharmacy dispensations, was conducted. Individuals with an initial HCV-negative test result followed by 1 additional test between January 1, 2000, and December 31, 2017, and who had no history of substance use at baseline (first HCV-negative test), were included. Participants were followed up from baseline to the last HCV-negative test or estimated date of seroconversion (midpoint between HCV-positive and the preceding HCV-negative test). Exposures: Episodes of prescription opioid use for noncancer pain were defined as acute (<90 days) or long-term (≥90 days). Prescription opioid exposure status (long-term vs prescription opioid-naive/acute) was treated as time-varying in survival analyses. In secondary analyses, long-term exposure was stratified by intensity of use (chronic vs. episodic) and by average daily dose in morphine equivalents (MEQ). Main Outcomes and Measures: Multivariable Cox regression models were used to assess the association between time-varying prescription opioid status and HCV seroconversion. Results: A total of 382 478 individuals who had more than 1 HCV test were included, of whom more than half were female (224 373 [58.7%]), born before 1974 (201 944 [52.8%]), and younger than 35 years at baseline (196 298 [53.9%]). Participants were followed up for 2 057 668 person-years and 1947 HCV seroconversions occurred. Of the participants, 41 755 people (10.9%) were exposed to long-term prescription opioid therapy at baseline or during follow-up. The HCV seroconversion rate per 1000 person-years was 0.8 among the individuals who were prescription opioid-naive/acute (1489 of 1947 [76.5%] seroconversions; 0.4% seroconverted within 5 years) and 2.1 with long-term prescription opioid therapy (458 of 1947 [23.5%] seroconversions; 1.1% seroconverted within 5 years). In multivariable analysis, exposure to long-term prescription opioid therapy was associated with a 3.2-fold (95% CI, 2.9-3.6) higher risk of HCV seroconversion (vs prescription opioid-naive/acute). In separate Cox models, long-term chronic use was associated with a 4.7-fold higher risk of HCV seroconversion (vs naive/acute use 95% CI, 3.9-5.8), and long-term higher-dose use (≥90 MEQ) was associated with a 5.1-fold higher risk (vs naive/acute use 95% CI, 3.7-7.1). Conclusions and Relevance: In this cohort study of people with more than 1 HCV test, long-term prescription opioid therapy for noncancer pain was associated with a higher risk of HCV seroconversion among individuals who were injection drug use-naive at baseline or at prescription opioid initiation. These results suggest injection drug use initiation risk is higher among people dispensed long-term therapy and may be useful for informing approaches to identify and prevent HCV infection. These findings should not be used to justify abrupt discontinuation of long-term therapy, which could increase risk of harms.
Databáze:	MEDLINE
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