本文由小咖机器人翻译整理

期刊来源：BMJ

原文链接：https://doi.org/10.1136/bmj-2023-076336

摘要内容如下：

目标

确定在用药过量和新冠肺炎的双重突发公共卫生事件期间，阿片类药物和兴奋剂风险缓解指南（RMG）的分配对死亡率和急性护理就诊的影响。

设计

基于人群的回顾性队列研究。

设置

加拿大不列颠哥伦比亚省。

参与者

从2020年3月27日至2021年8月31日，5882名阿片类药物或兴奋剂使用障碍患者接受了阿片类药物（n=5356）和/或兴奋剂（n=1061）的RMG处方（535人同时接受了这两种药物）。

主要结局指标

RMG阿片类药物或兴奋剂分配后一周内的全因和用药过量特异性死亡率和急性护理访视。通过使用高维倾向评分匹配，将RMG接受者与对照组进行1:1匹配。边际结构模型，在每周的时间步骤上执行，用于测量分配对结果的影响。

结果

一天或更长时间的RMG阿片类药物分配与随后一周的全因死亡率（调整后的风险比为0.39，95%置信区间为0.25至0.60）和用药过量相关死亡率（0.45，0.27至0.75）的降低相关。RMG兴奋剂的分配（≥1天）与全因死亡率（调整后的风险比为0.50，0.20至1.23）或用药过量相关死亡率（0.53，0.18至1.56）的降低无显著相关性。RMG阿片类药物分配的保护作用随着给定的一周内药物分配天数的增加而增加。与对照组相比，接受4天或更长时间的RMG阿片类药物分配的患者降低了全因死亡率（调整后的风险比为0.09，0.04至0.21）和用药过量相关死亡率（0.11，0.04至0.32）。阿片类药物RMG的分配并未显著改变所有原因或用药过量相关的急性护理就诊的几率。RMG兴奋剂的分配与任何原因的急性护理就诊的几率显著降低相关，但不影响用药过量相关的急性护理就诊的几率。

结论

在阿片类药物使用障碍患者样本中，RMG阿片类药物分配与减少用药过量相关死亡率和全因死亡率相关。替代非法药物供应的药物是有希望降低阿片类药物使用障碍患者死亡率的干预措施。

英文原文如下：

Abstracts

OBJECTIVE  To determine the effect of opioid and stimulant Risk Mitigation Guidance (RMG) dispensations on mortality and acute care visits during the dual public health emergencies of overdose and covid-19.

DESIGN  Population based retrospective cohort study.

SETTING  British Columbia, Canada.

PARTICIPANTS  5882 people with opioid or stimulant use disorder who received RMG prescriptions for opioids (n=5356) and/or stimulants (n=1061) (535 received both) from 27 March 2020 to 31 August 2021.

MAIN OUTCOME MEASURES  All cause and overdose specific mortality and acute care visits in the week after RMG opioid or stimulant dispensation. RMG recipients were matched 1:1 with controls through use of high dimensional propensity score matching. Marginal structural models, executed on weekly time steps, were used to measure the effect of dispensations on outcomes.

RESULTS  RMG opioid dispensations of one day or more were associated with reduced all cause mortality (adjusted hazard ratio 0.39, 95% confidence interval 0.25 to 0.60) and overdose related mortality (0.45, 0.27 to 0.75) in the subsequent week. Dispensations of RMG stimulants (≥1 days) were not significantly associated with reduced all cause mortality (adjusted hazard ratio 0.50, 0.20 to 1.23) or overdose related mortality (0.53, 0.18 to 1.56). The protective effect of RMG opioid dispensations increased with the number of days the medications were dispensed in a given week. People who received four or more days of RMG opioid dispensations had reduced all cause mortality (adjusted hazard ratio 0.09, 0.04 to 0.21) and overdose related mortality (0.11, 0.04 to 0.32) compared with the control group. Opioid RMG dispensations did not significantly modify the odds of all cause or overdose related acute care visits. Dispensations of RMG stimulants were associated with a significant decrease in the odds of acute care visits for any cause but did not affect the odds of overdose related acute care visits.

CONCLUSIONS  RMG opioid dispensations were associated with reduced overdose related and all cause mortality among a sample of people with opioid use disorder. Pharmaceutical alternatives to the illegal drug supply are promising interventions to reduce mortality in people with opioid use disorder.

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