Risk Factors for Serious Prescription Opioid-Induced Respiratory Depression or Overdose: Comparison of Commercially Insured and Veterans Health Affairs Populations

Autor: Andrew R Joyce, Marie Barnard, Pramit Nadpara, Norman V. Carroll, Nathan W. Carroll, Barbara K. Zedler, E Lenn Murrelle
Rok vydání: 2017
Předmět:
Adult
Male
medicine.medical_specialty
Databases
Factual
Overdose
Population
Insurance Claim Review
03 medical and health sciences
0302 clinical medicine
Risk Factors
Original Research Articles
Internal medicine
medicine
Humans
030212 general & internal medicine
Medical prescription
Risk factor
Psychiatry
education
Depression (differential diagnoses)
education.field_of_study
business.industry
General Medicine
Odds ratio
Middle Aged
Respiratory Depression
medicine.disease
OPIOIDS & SUBSTANCE USE DISORDERS SECTION
United States
Analgesics
Opioid
Opioids
Substance abuse
United States Department of Veterans Affairs
Anesthesiology and Pain Medicine
Opioid
Case-Control Studies
Female
Neurology (clinical)
Drug Overdose
Respiratory Insufficiency
business
030217 neurology & neurosurgery
Methadone
medicine.drug
Zdroj: Pain Medicine: The Official Journal of the American Academy of Pain Medicine
ISSN: 1526-4637
1526-2375
DOI: 10.1093/pm/pnx038
Popis: Objective To characterize the risk factors associated with overdose or serious opioid-induced respiratory depression (OIRD) among medical users of prescription opioids in a commercially insured population (CIP) and to compare risk factor profiles between the CIP and Veterans Health Administration (VHA) population. Subjects and Methods Analysis of data from 18,365,497 patients in the IMS PharMetrics Plus health plan claims database (CIP) who were dispensed a prescription opioid in 2009 to 2013. Baseline factors associated with an event of serious OIRD among 7,234 cases and 28,932 controls were identified using multivariable logistic regression. The CIP risk factor profile was compared with that from a corresponding logistic regression among 817 VHA cases and 8,170 controls in 2010 to 2012. Results The strongest associations with serious OIRD in CIP were diagnosed substance use disorder (odds ratio [OR] = 10.20, 95% confidence interval [CI] = 9.06–11.40) and depression (OR = 3.12, 95% CI = 2.84–3.42). Other strongly associated factors included other mental health disorders; impaired liver, renal, vascular, and pulmonary function; prescribed fentanyl, methadone, and morphine; higher daily opioid doses; and concurrent psychoactive medications. These risk factors, except depression, vascular disease, and specific opioids, largely aligned with VHA despite CIP being substantially younger, including more females and less chronic disease, and having greater prescribing prevalence of higher daily opioid doses, specific opioids, and most selected nonopioids. Conclusions Risk factor profiles for serious OIRD among US medical users of prescription opioids with private or public health insurance were largely concordant despite substantial differences between the populations in demographics, clinical conditions, health care delivery systems, and clinical practices.
Databáze: OpenAIRE
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