Association between opioid prescribing patterns and opioid overdose-related deaths.

摘要: Context The rate of prescription opioid–related overdose death increased substantially in the United States over past decade. Patterns opioid prescribing may be related to risk mortality. Objective To examine association maximum prescribed daily dose and dosing schedule (“as needed,” regularly scheduled, or both) with among patients cancer, chronic pain, acute substance use disorders. Design Case-cohort study. Setting Veterans Health Administration (VHA), 2004 through 2008. Participants All unintentional decedents (n = 750) a random sample (n = 154 684) those individuals who used medical services 2005 received therapy for pain. Main Outcome Measure Associations regimens (dose schedule) by subgroups defined clinical diagnoses, adjusting age group, sex, race, ethnicity, comorbid conditions. Results frequency fatal study period treated opioids was estimated 0.04%.The directly medication. adjusted hazard ratios (HRs) associated 100 mg/d more, compared category 1 less than 20 mg/d, were as follows: disorders, HR = 4.54 (95% confidence interval [CI], 2.46-8.37; absolute difference approximation [ARDA] = 0.14%); HR = 7.18 CI, 4.85-10.65; ARDA = 0.25%); HR = 6.64 3.31-13.31; ARDA = 0.23%); HR = 11.99 4.42-32.56; ARDA = 0.45%). Receiving both as-needed scheduled doses not after adjustment. Conclusion Among receiving prescriptions higher death.