PDF(Sci-hub)
Abstract：
To assess missed opportunities for reducing fatal opioid overdoses, characteristics of decedents by opioid overdose with and without problematic opioid use who received health care services within one year of death were examined.
Of 157 decedents in the Worcester, Massachusetts, area between 2008 and 2012, 112 had contact with the health care system. Electronic medical records were reviewed for clinical characteristics, health service use, universal precautions, and substance use disorder management. Problematic opioid use was defined as individuals having documented opioid use disorders or aberrant drug-related behavior. Data were analyzed with chi-square tests with adjusted residual for categorical variables and t tests for continuous variables.
Decedents were predominantly Caucasian males with a mean±SD age of 41.0±11.7. Problematic opioid use by definition meant users (N=53) had opioid use disorder as a principal diagnosis and were likely to have a comorbid substance use disorder. Decedents with nonproblematic opioid use had diagnoses of chronic pain and mental illness. They were more likely to have been seen last in surgical and subspecialty settings (29% versus 11%). The proportion with an opioid prescription was higher among those with problematic use (72% versus 37%) who also had a higher total daily morphine equivalent, compared with those with nonproblematic use (165.4±282.7 versus 55.6±117.7 mg per day).
Persons with problematic opioid use are a recognizable group with a high risk of death by opioid overdose whose therapeutic management needs improvement to reduce fatal outcomes. Different strategies must be developed for identifying and treating nonproblematic opioid use to reduce risk of death.
Of 157 decedents in the Worcester, Massachusetts, area between 2008 and 2012, 112 had contact with the health care system. Electronic medical records were reviewed for clinical characteristics, health service use, universal precautions, and substance use disorder management. Problematic opioid use was defined as individuals having documented opioid use disorders or aberrant drug-related behavior. Data were analyzed with chi-square tests with adjusted residual for categorical variables and t tests for continuous variables.
Decedents were predominantly Caucasian males with a mean±SD age of 41.0±11.7. Problematic opioid use by definition meant users (N=53) had opioid use disorder as a principal diagnosis and were likely to have a comorbid substance use disorder. Decedents with nonproblematic opioid use had diagnoses of chronic pain and mental illness. They were more likely to have been seen last in surgical and subspecialty settings (29% versus 11%). The proportion with an opioid prescription was higher among those with problematic use (72% versus 37%) who also had a higher total daily morphine equivalent, compared with those with nonproblematic use (165.4±282.7 versus 55.6±117.7 mg per day).
Persons with problematic opioid use are a recognizable group with a high risk of death by opioid overdose whose therapeutic management needs improvement to reduce fatal outcomes. Different strategies must be developed for identifying and treating nonproblematic opioid use to reduce risk of death.
摘要：
评估减少致命阿片类药物过量的错失机会，研究了在死亡后一年内接受医疗保健服务的阿片类药物过量和无阿片类药物使用问题的死者的特征.
在伍斯特的157名死者中,马萨诸塞州,在2008年至2012年期间，有112人与医疗保健系统有过接触。审查了电子病历的临床特征，卫生服务使用，普遍的预防措施，和物质使用障碍管理。有问题的阿片类药物使用被定义为有记录的阿片类药物使用障碍或异常药物相关行为的个体。对数据进行卡方检验，对分类变量进行调整残差，对连续变量进行t检验。
死者主要是白种人男性，平均±SD年龄为41.0±11.7岁。根据定义，阿片类药物使用问题是指使用者（N=53）将阿片类药物使用障碍作为主要诊断，并且可能患有共病物质使用障碍。使用阿片类药物不成问题的死者诊断为慢性疼痛和精神疾病。在手术和亚专科设置中，他们更有可能出现在最后一次（29％对11％）。阿片类药物处方的比例在有问题的人中较高（72％对37％），每天吗啡总当量也较高，与无问题使用的患者相比（每天165.4±282.7对55.6±117.7mg）。
阿片类药物使用有问题的人是一个公认的群体，因阿片类药物过量而死亡的风险很高，其治疗管理需要改进以减少致命后果。必须制定不同的策略来识别和治疗无问题的阿片类药物使用，以降低死亡风险。
在伍斯特的157名死者中,马萨诸塞州,在2008年至2012年期间，有112人与医疗保健系统有过接触。审查了电子病历的临床特征，卫生服务使用，普遍的预防措施，和物质使用障碍管理。有问题的阿片类药物使用被定义为有记录的阿片类药物使用障碍或异常药物相关行为的个体。对数据进行卡方检验，对分类变量进行调整残差，对连续变量进行t检验。
死者主要是白种人男性，平均±SD年龄为41.0±11.7岁。根据定义，阿片类药物使用问题是指使用者（N=53）将阿片类药物使用障碍作为主要诊断，并且可能患有共病物质使用障碍。使用阿片类药物不成问题的死者诊断为慢性疼痛和精神疾病。在手术和亚专科设置中，他们更有可能出现在最后一次（29％对11％）。阿片类药物处方的比例在有问题的人中较高（72％对37％），每天吗啡总当量也较高，与无问题使用的患者相比（每天165.4±282.7对55.6±117.7mg）。
阿片类药物使用有问题的人是一个公认的群体，因阿片类药物过量而死亡的风险很高，其治疗管理需要改进以减少致命后果。必须制定不同的策略来识别和治疗无问题的阿片类药物使用，以降低死亡风险。
