The association between non-concordance with the Canadian guideline for safe and effective use of opioids in chronic non-cancer pain and opioid overdose death in Quebec
Notice bibliographique
Résumé
Background: In Canada, the United States of America (U.S.A), and many other regions world-wide, more and more people are dying of prescription opioid analgesic (POA) overdose death. The death rate from POA overdose has quadrupled in the U.S.A. since 1999 and tripled in Ontario. These pharmaceuticals remain useful and important tools in the practice of medicine, although many have suggested changes to prescribing behavior should be among the intervention strategies to curb this epidemic. Canadian physicians wish to minimize overdose and other opioid related-harms while using these medications to optimal clinical effectiveness. To assist physicians in achieving this balance, a national collaboration examined evidence and published the Canadian Guideline for Safe and Effective use of Opioids in Non-Cancer Pain (CGCNCP) in 2010. We retrospectively assessed if non-concordance with prescription characteristic recommendations given in this guideline was predictive of overdose death. Methods: Using a nested-case control design within the public health insurance cohort of Quebec from 2001-2010, we examined the relationship between death from opioid overdose and dispensed opioid prescriptions non-concordant with recommendations in the CGCNCP. Cases meeting criteria for prescription opioid overdose death were identified through provincial coroner and death certificate data and were restricted to individuals with pharmaceutical insurance from the Régie d'Assurance Maladie du Québec (RAMQ) in the 210 days prior to overdose death. Individuals with an active cancer diagnosis were excluded because of substantial differences in prescribing recommendations in cancer-related pain management. Controls were sampled randomly from time, age, and sex matched individuals in the same cohort and subject to the same inclusion criteria. Non-concordance was assessed through longitudinal analysis of data on prescriptions dispensed in the 180 days prior to case death. We used conditional logistic regression to estimate the magnitude of the relationship between number of non-concordance events and overdose death. Results: Five hundred people who died of POA overdose while covered by RAMQ pharmaceutical insurance were dispensed at least one POA in the 180 days prior to death, of which 73 had an age, sex, and time-matched control who had also been dispensed at least one POA in the same period. There were 1,326 dispensed opioid prescriptions among cases, with a total of 375 non-concordant events, and 469 dispensed opioid prescriptions among controls, with a total of 111 non-concordant events. In multivariate analysis, POA overdose death was associated with the number of dispensed benzodiazepine prescriptions (aOR 2.91; 95% CI 1.21-7.00), and opioid prescriptions (aOR 1.20; 95% CI 1.02-1.40), as well as initiating opioid therapy with an extended release formulation (aOR 6.38; 95% CI 1.07-37.94). Total number of non-concordance events was not significantly associated with POA overdose death (aOR 1.03; 95% CI 0.88-1.21). Interpretation: Increased numbers of dispensed opioid and benzodiazepine prescriptions are important risk factors for POA overdose death in Quebec. Prescription of extended release opioids to opioid naïve patients is significantly associated with increased odds of POA overdose death; prescribers should initiate therapy using immediate release formulations and transition patients to extended release when stable dosing is established. Further study with a larger number of cases is needed to determine whether non-concordance with additional CGCNCP recommendations is associated with POA overdose death.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,006 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,002 | 0,001 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,002 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».