Background

Opioid-overdose deaths are associated with poisoning with prescription and illicit opioids in the USA. In contrast, opioid-related deaths (ORDs) in the UK often involve drugs and substances of misuse, and may not be associated with a high dose of prescribed opioids. This study aimed to investigate the association between prescribed opioid dose and ORDs in UK primary care.

Methods

This case-crossover study used the Clinical Practice Research Datalink and death registration between 2000 and 2015 to identify ORDs. Daily oral morphine equivalent (OMEQ) dose was measured within a 90 day focal window before ORD and three earlier reference windows. Conditional logistic regression models assessed the adjusted odds ratio (aOR) and 95% confidence interval (95% CI) comparing daily OMEQ dose greater than 120 mg in the focal window against the reference windows.

Results

Of the 232 ORDs, 62 (26.7%) were not prescribed opioids in the year before death. Of the remaining 170 cases, 50 (29.4%) were never prescribed a daily OMEQ dose greater than 50 mg. Daily OMEQ doses over 120 mg (aOR 2.20; 95% CI: 1.06–4.56), co-prescribing gabapentinoids (aOR 2.32; 95% CI: 1.01–5.33), or some antidepressants (aOR 3.03; 95% CI: 1.02–9.04) significantly increased the risk of ORD.

Conclusions

Daily OMEQ dose greater than 120 mg and the concomitant use of psychotropic medicines were related to ORDs in the UK. Prescribers should cautiously avoid prescribing opioids with a daily OMEQ dose greater than 120 mg day⁻¹ and the combination of opioids and gabapentinoids, even with low opioid doses.

中文翻译：

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英国阿片类药物相关死亡与处方阿片类药物剂量和精神药物之间的关联：病例交叉研究

背景

在美国，阿片类药物过量死亡与处方药和非法阿片类药物中毒有关。相比之下，英国的阿片类药物相关死亡 (ORD) 通常涉及滥用药物和物质，并且可能与高剂量的处方阿片类药物无关。本研究旨在调查英国初级保健中阿片类药物处方剂量与 ORD 之间的关联。

方法

这项病例交叉研究使用了 2000 年至 2015 年间的临床实践研究数据链和死亡登记来识别 ORD。在 ORD 之前的 90 天焦点窗口和三个较早的参考窗口内测量每日口服吗啡当量 (OMEQ) 剂量。条件逻辑回归模型评估了调整后的优势比 (aOR) 和 95% 置信区间 (95% CI)，将焦点窗口中大于 120 mg 的每日 OMEQ 剂量与参考窗口进行比较。

结果

在 232 份 ORD 中，62 份（26.7%）在死亡前一年未使用阿片类药物。在剩余的 170 例中，50 例 (29.4%) 的每日 OMEQ 剂量从未超过 50 mg。每日 OMEQ 剂量超过 120 毫克（aOR 2.20；95% CI：1.06–4.56），共同处方加巴喷丁（aOR 2.32；95% CI：1.01–5.33），或一些抗抑郁药（aOR 3.03–9.52% CI：105%） ) 显着增加 ORD 的风险。

结论

在英国，每日 OMEQ 剂量大于 120 毫克和同时使用精神药物与 ORD 相关。开具处方者应谨慎避免开具每日 OMEQ 剂量大于 120 mg day ^-1的阿片类药物以及阿片类药物和加巴喷丁类药物的组合，即使是低阿片类药物剂量。