AIMS To examine how the risks of incident opioid use disorder (OUD), nonfatal and fatal overdose have changed over time among opioid-naïve individuals receiving an initial opioid prescription. DESIGN Retrospective, longitudinal study using the Massachusetts Chapter 55 dataset which linked multiple administrative datasets to study the opioid epidemic. We identified the cumulative incidence of OUD, nonfatal and fatal overdose among the opioid-naïve initiating opioid treatment in Massachusetts from 2011 to 2014 and estimated rates of these outcomes at 6 months and at 1, 2, 3 and 4 years through 2015. We used Cox regression to examine the association between characteristics of the initial prescription and risk of these outcomes. SETTING Massachusetts, USA PARTICIPANTS: Massachusetts residents age ≥11 years in 2011-2015 who were opioid-naïve (no opioid prescriptions or evidence of OUD in the 6 months prior to the index prescription) (n=2,154,426). The mean age was 49.1 years, 55.3% were female and 47.3% had commercial insurance. MEASUREMENTS Opioid prescriptions were identified in the Prescription Monitoring Program (PMP) database, as were the characteristics of the initial prescription database. The outcomes of OUD and nonfatal overdose were identified from claims in the APCD and hospital encounters in the Acute Hospital Case Mix Files. Fatal overdoses were identified using Registry of Vital Records and Statistics (RVRS) death certificates and the Office of the Chief Medical Examiner (OCME) circumstances of death and toxicology reports. FINDINGS Among opioid-naïve individuals receiving an initial opioid prescription, the risk of incident OUD appears to have declined between 2011 and 2014, while rates of overdose were largely unchanged. For example, the 1-year OUD rate was 1.2% in 2011, 1.1% in 2012, 1.3% in 2013 and 0.9% in 2014. Longer therapy duration was associated with higher risk of OUD (HR 2.24, 95% CI 2.19-2.29 for duration of 3 or more months), nonfatal (HR 1.67, 95% CI 1.53-1.82) and fatal opioid overdose (HR 2.24, 95% CI 1.91-2.6). Concurrent benzodiazepine treatment was also associated with higher risk of OUD (HR 1.14, 95% CI 1.12-1.17), nonfatal (HR 1.20, 95% CI 1.10-1.30) and fatal overdose (HR 1.86, 95% CI 1.61-2.16). CONCLUSIONS Among opioid-naïve individuals in Massachusetts receiving an initial opioid prescription, the risk of incident opioid use disorder (OUD) appears to have declined between 2011 and 2014, while rates of overdose were largely unchanged. Longer therapy duration and concurrent benzodiazepines were associated with higher rates of OUD and opioid overdose.

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2011 年至 2014 年马萨诸塞州接受阿片类药物处方的未使用阿片类药物的个体中阿片类药物使用障碍和药物过量的趋势

目的 研究阿片类药物使用障碍 (OUD)、非致死性和致死性用药过量的风险在接受初始阿片类药物处方的未使用阿片类药物的个体中随时间发生的变化。设计 使用马萨诸塞州第 55 章数据集进行回顾性纵向研究，该数据集将多个行政数据集联系起来以研究阿片类药物的流行。我们确定了 2011 年至 2014 年马萨诸塞州未接受阿片类药物初始阿片类药物治疗的 OUD、非致死性和致死性过量使用的累积发生率，并估计了这些结果在 6 个月以及 1、2、3 和 4 年（到 2015 年）的发生率。我们使用了Cox 回归以检查初始处方的特征与这些结果的风险之间的关联。设置美国马萨诸塞州的参与者：2011-2015 年年龄≥11 岁且未使用过阿片类药物（在指数处方前 6 个月内没有阿片类药物处方或 OUD 证据）的马萨诸塞州居民 (n=2,154,426)。平均年龄为 49.1 岁，55.3% 为女性，47.3% 有商业保险。测量 阿片类药物处方在处方监测计划 (PMP) 数据库中确定，初始处方数据库的特征也是如此。从 APCD 中的索赔和急性医院病例混合文件中的医院遭遇中确定了 OUD 和非致命性过量的结果。使用生命记录和统计登记处 (RVRS) 死亡证明以及首席法医办公室 (OCME) 的死亡情况和毒理学报告确定了致命的过量用药。结果 在接受初始阿片类药物处方的阿片类药物初治者中，发生 OUD 的风险似乎在 2011 年至 2014 年间有所下降，而过量服用率基本没有变化。例如，2011 年的 1 年 OUD 率为 1.2%，2012 年为 1.1%，2013 年为 1.3%，2014 年为 0.9%。更长的治疗持续时间与更高的 OUD 风险相关（HR 2.24，95% CI 2.19-2.29）持续 3 个月或更长时间）、非致死性（HR 1.67，95% CI 1.53-1.82）和致死性阿片类药物过量（HR 2.24，95% CI 1.91-2.6）。同时使用苯二氮卓类药物也与更高的 OUD 风险（HR 1.14，95% CI 1.12-1.17）、非致命性（HR 1.20，95% CI 1.10-1.30）和致死性过量（HR 1.86，95% CI 1.61-2.16）风险相关。结论 在马萨诸塞州接受阿片类药物初始处方的未使用阿片类药物的个体中，2011 年至 2014 年期间，发生阿片类药物使用障碍 (OUD) 的风险似乎有所下降，而过量服用率基本没有变化。较长的治疗持续时间和同时使用苯二氮卓类药物与较高的​​ OUD 和阿片类药物过量发生率相关。