A nested case-control study was conducted using the 2012-2018, 5% national Medicare claims data. Older adults with chronic non-cancer pain (CNCP) who were receiving long-term opioid therapy (LTOT) were included in the study. Cases were defined as individuals experiencing mental health crisis events; controls were identified using incidence density sampling. The opioid tapering velocity was measured in the 120-day hazard period that yielded a monthly percentage of dose change. Conditional logistic regression was used to assess the relationship of interest.
A total of 42 091 older adults with CNCP were eligible for the study. Cases (n = 952) were matched with controls in a 1:2 ratio based on age (±1 year) and time of cohort entry (±30 days). A higher percentage of controls (67.65%) were on steady dose compared with cases (59.03%). In the adjusted model, tapering (aOR = 1.36; 95% CI: 1.02-1.83), rapid tapering (aOR = 1.45; 95% CI: 1.11-1.91), and dose escalation (aOR = 1.78; 95% CI: 1.32-2.39) were significantly associated with the mental health crisis, compared with steady dose.
Both opioid tapering and dose escalation are associated with mental health crisis events. Patient-driven and gradual dose tapering, as recommended by prescribing guidelines, should be promoted to prevent mental health crisis events among older adults on LTOT.
方法:使用2012-2018年5%的国家医疗保险索赔数据进行了嵌套病例对照研究。该研究包括接受长期阿片类药物治疗(LTOT)的患有慢性非癌性疼痛(CNCP)的老年人。病例定义为经历心理健康危机事件的个体;使用发生率密度抽样确定对照。在120天的危险期内测量了阿片样物质的渐缩速度,该过程产生了每月的剂量变化百分比。使用条件逻辑回归来评估感兴趣的关系。
结果:共有42091名患有CNCP的老年人符合研究条件。根据年龄(±1年)和队列进入时间(±30天),病例(n=952)与对照组以1:2的比例进行匹配。与病例(59.03%)相比,稳定剂量的对照组(67.65%)比例更高。在调整后的模型中,渐缩(AOR=1.36;95%CI:1.02-1.83),快速变细(aOR=1.45;95%CI:1.11-1.91),和剂量递增(aOR=1.78;95%CI:1.32-2.39)与心理健康危机显著相关,与稳定剂量相比。
结论:阿片类药物逐渐减少和剂量增加都与心理健康危机事件相关。患者驱动和逐渐减少剂量,根据处方指南的建议,应促进在LTOT上预防老年人的心理健康危机事件。