Prescription Opioid Dose Reductions and Potential Adverse Events: a Multi-site Observational Cohort Study in Diverse US Health Systems.

Autor: Metz VE; Kaiser Permanente Northern California, Division of Research, Center for Addiction and Mental Health Research, Oakland, CA, USA. verena.e.metz@kp.org., Ray GT; Kaiser Permanente Northern California, Division of Research, Center for Addiction and Mental Health Research, Oakland, CA, USA., Palzes V; Kaiser Permanente Northern California, Division of Research, Center for Addiction and Mental Health Research, Oakland, CA, USA., Binswanger I; Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, USA.; Colorado Permanente Medical Group, Denver, CO, USA.; Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA.; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA., Altschuler A; Kaiser Permanente Northern California, Division of Research, Center for Addiction and Mental Health Research, Oakland, CA, USA., Karmali RN; Mathematica, Oakland, CA, USA., Ahmedani BK; Center for Health Policy & Health Services Research, Henry Ford Health, Detroit, MI, USA., Andrade SE; Meyers Primary Care Institute, University of Massachusetts Chan Medical School, Worcester, MA, USA., Boscarino JA; Department of Population Health Sciences, Geisinger Clinic, Danville, PA, USA., Clark RE; Department of Family Medicine and Community Health, University of Massachusetts Chan School of Medicine, Worcester, MA, USA., Haller IV; Essentia Institute of Rural Health, Duluth, MN, USA., Hechter RC; Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA., Roblin DW; Mid-Atlantic Permanente Research Institute, Kaiser Permanente, Rockville, MD, USA., Sanchez K; Baylor Scott & White Research Institute, Dallas, TX, USA.; School of Social Work, University of Texas at Arlington, Arlington, TX, USA., Bailey SR; Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA., McCarty D; OHSU-PSU School of Public Health, Portland, OR, USA.; Division of General and Internal Medicine, School of Medicine, Oregon Health and Science University, Portland, OR, USA., Stephens KA; Department of Family Medicine, University of Washington, Seattle, WA, USA., Rosa CL; Center for the Clinicals Trials Network, National Institute On Drug Abuse, National Institutes of Health, Bethesda, MD, USA., Rubinstein AL; Department of Pain Medicine, The Permanente Medical Group, Santa Rosa, CA, USA., Campbell CI; Kaiser Permanente Northern California, Division of Research, Center for Addiction and Mental Health Research, Oakland, CA, USA.; Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA, USA.
Jazyk: angličtina
Zdroj: Journal of general internal medicine [J Gen Intern Med] 2024 May; Vol. 39 (6), pp. 1002-1009. Date of Electronic Publication: 2023 Nov 06.
DOI: 10.1007/s11606-023-08459-y
Abstrakt: Background: In response to the opioid crisis in the United States, population-level prescribing of opioids has been decreasing; there are concerns, however, that dose reductions are related to potential adverse events.
Objective: Examine associations between opioid dose reductions and risk of 1-month potential adverse events (emergency department (ED) visits, opioid overdose, benzodiazepine prescription fill, all-cause mortality).
Design: This observational cohort study used electronic health record and claims data from eight United States health systems in a prescription opioid registry (Clinical Trials Network-0084). All opioid fills (excluding buprenorphine) between 1/1/2012 and 12/31/2018 were used to identify baseline periods with mean morphine milligram equivalents daily dose of  ≥ 50 during six consecutive months.
Patients: We identified 60,040 non-cancer patients with  ≥ one 2-month dose reduction period (600,234 unique dose reduction periods).
Main Measures: Analyses examined associations between dose reduction levels (1- < 15%, 15- < 30%, 30- < 100%, 100% over 2 months) and potential adverse events in the month following a dose reduction using logistic regression analysis, adjusting for patient characteristics.
Key Results: Overall, dose reduction periods involved mean reductions of 18.7%. Compared to reductions of 1- < 15%, dose reductions of 30- < 100% were associated with higher odds of ED visits (OR 1.14, 95% CI 1.10, 1.17), opioid overdose (OR 1.41, 95% CI 1.09-1.81), and all-cause mortality (OR 1.39, 95% CI 1.16-1.67), but lower odds of a benzodiazepine fill (OR 0.83, 95% CI 0.81-0.85). Dose reductions of 15- < 30%, compared to 1- < 15%, were associated with higher odds of ED visits (OR 1.08, 95% CI 1.05-1.11) and lower odds of a benzodiazepine fill (OR 0.93, 95% CI 0.92-0.95), but were not associated with opioid overdose and all-cause mortality.
Conclusions: Larger reductions for patients on opioid therapy may raise risk of potential adverse events in the month after reduction and should be carefully monitored.
(© 2023. The Author(s), under exclusive licence to Society of General Internal Medicine.)
Databáze: MEDLINE
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