退伍军人中阿片类药物过量死亡和处方阿片类药物使用的变化趋势。
Changing Trends in Opioid Overdose Deaths and Prescription Opioid Receipt Among Veterans.
机构信息
Department of Psychiatry, University of Michigan, Ann Arbor, Michigan; Center for Clinical Management Research, Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan.
Serious Mental Illness Treatment Resource and Evaluation Center, VA Office of Mental Health and Suicide Prevention, Ann Arbor, Michigan.
出版信息
Am J Prev Med. 2019 Jul;57(1):106-110. doi: 10.1016/j.amepre.2019.01.016. Epub 2019 May 22.
INTRODUCTION
To inform overdose prevention, this study assessed both recent trends in opioid overdose mortality across opioid categories and receipt of prescription opioid analgesics among Veterans who died from overdose in the Veterans Health Administration.
METHODS
Using Veterans Health Administration records linked to National Death Index data, annual cohorts (2010-2016) of Veterans who received Veterans Health Administration care were obtained and were examined by opioid overdose categories (natural/semisynthetic opioids, heroin, methadone, and other synthetic opioids) on (1) overdose rates and changes in rates adjusted for age, sex, and race/ethnicity; and (2) Veterans Health Administration prescription opioid receipt. Analyses were conducted in 2018.
RESULTS
The overall rate of opioid overdose among Veterans increased from 14.47 per 100,000 person-years in 2010 to 21.08 per 100,000 person-years in 2016 (adjusted rate ratio=1.65, 95% CI=1.51, 1.81). There was a decline in methadone overdose (adjusted rate ratio=0.66, 95% CI=0.51, 0.84) and no significant change in natural/semisynthetic opioid overdose (adjusted rate ratio=1.08, 95% CI=0.94, 1.24). However, the synthetic opioid overdose rate (adjusted rate ratio=5.46, 95% CI=4.41, 6.75) and heroin overdose rate (adjusted rate ratio=4.91, 95% CI=3.92, 6.15) increased substantially. Among all opioid overdose decedents, prescription opioid receipt within 3 months before death declined from 54% in 2010 to 26% in 2016.
CONCLUSIONS
Opioid overdose rates among Veterans Health Administration Veterans increased because of increases in heroin and synthetic opioid overdose rates. Prescriptions of opioids declined among patients who died from all categories of opioid overdose; by 2016, only a minority received an opioid analgesic from Veterans Health Administration within 3 months of overdose. Future prevention efforts should extend beyond patients actively receiving opioid prescriptions.
简介
为了提供过量用药预防信息，本研究评估了退伍军人健康管理局中，不同类别的阿片类药物过量死亡的近期趋势，以及在因过量用药而死亡的退伍军人中，他们接受处方类阿片类药物镇痛剂的情况。
方法
利用退伍军人健康管理局记录与国家死亡指数数据的关联，获取了退伍军人健康管理局护理的年度队列（2010-2016 年），并根据阿片类药物过量类别（天然/半合成阿片类药物、海洛因、美沙酮和其他合成阿片类药物）进行了检查：（1）调整年龄、性别和种族/民族因素后的过量用药率和变化率；（2）退伍军人健康管理局开具的处方类阿片类药物接受情况。分析于 2018 年进行。
结果
退伍军人的总体阿片类药物过量用药率从 2010 年的每 10 万人年 14.47 例上升到 2016 年的每 10 万人年 21.08 例（调整后的比率比=1.65，95%置信区间=1.51，1.81）。美沙酮过量用药率下降（调整后的比率比=0.66，95%置信区间=0.51，0.84），天然/半合成阿片类药物过量用药率无显著变化（调整后的比率比=1.08，95%置信区间=0.94，1.24）。然而，合成阿片类药物过量用药率（调整后的比率比=5.46，95%置信区间=4.41，6.75）和海洛因过量用药率（调整后的比率比=4.91，95%置信区间=3.92，6.15）大幅增加。在所有阿片类药物过量死亡者中，在死亡前 3 个月内接受处方类阿片类药物的比例从 2010 年的 54%下降到 2016 年的 26%。
结论
退伍军人健康管理局退伍军人的阿片类药物过量用药率增加，原因是海洛因和合成阿片类药物过量用药率增加。在所有类别的阿片类药物过量死亡患者中，开具的阿片类药物处方减少；到 2016 年，只有少数人在过量用药后 3 个月内从退伍军人健康管理局获得阿片类药物镇痛剂。未来的预防工作应超出正在接受阿片类药物处方的患者。
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