PDF(Pubmed)
Abstract：
Opioid tapering and discontinuation have increased in recent years with the implementation of national prescribing guidelines. This study aimed to examine the relationship between opioid tapering velocity and mental health crisis events in older Medicare beneficiaries.
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.
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.
摘要：
背景：近年来，随着国家处方指南的实施，阿片类药物的逐渐减少和停药有所增加。这项研究旨在研究阿片类药物逐渐减少的速度与老年Medicare受益人的心理健康危机事件之间的关系。
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。
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。
