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    Sex Differences in Dose Escalation and Overdose Death during Chronic Opioid Therapy: A Population-Based Cohort Study.

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    Author
    Kaplovitch, E; Gomes, T; Camacho, X; Dhalla, IA; Mamdani, MM; Juurlink, DN
    Date
    2015
    Source Title
    PLoS One
    Publisher
    Public Library of Science (PLoS)
    University of Melbourne Author/s
    Camacho, Ximena
    Affiliation
    Centre for Digital Transformation of Health
    Metadata
    Show full item record
    Document Type
    Journal Article
    Citations
    Kaplovitch, E., Gomes, T., Camacho, X., Dhalla, I. A., Mamdani, M. M. & Juurlink, D. N. (2015). Sex Differences in Dose Escalation and Overdose Death during Chronic Opioid Therapy: A Population-Based Cohort Study.. PLoS One, 10 (8), pp.e0134550-. https://doi.org/10.1371/journal.pone.0134550.
    Access Status
    Open Access
    URI
    http://hdl.handle.net/11343/257424
    DOI
    10.1371/journal.pone.0134550
    Open Access at PMC
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4546305
    Abstract
    BACKGROUND: The use of opioids for noncancer pain is widespread, and more than 16,000 die of opioid-related causes in the United States annually. The patients at greatest risk of death are those receiving high doses of opioids. Whether sex influences the risk of dose escalation or opioid-related mortality is unknown. METHODS AND FINDINGS: We conducted a cohort study using healthcare records of 32,499 individuals aged 15 to 64 who commenced chronic opioid therapy for noncancer pain between April 1, 1997 and December 31, 2010 in Ontario, Canada. Patients were followed from their first opioid prescription until discontinuation of therapy, death from any cause or the end of the study period. Among patients receiving chronic opioid therapy, 589 (1.8%) escalated to high dose therapy and n = 59 (0.2%) died of opioid-related causes while on treatment. After multivariable adjustment, men were more likely than women to escalate to high-dose opioid therapy (adjusted hazard ratio 1.44; 95% confidence interval 1.21 to 1.70) and twice as likely to die of opioid-related causes (adjusted hazard ratio 2.04; 95% confidence interval 1.18 to 3.53). These associations were maintained in a secondary analysis of 285,520 individuals receiving any opioid regardless of the duration of therapy. CONCLUSIONS: Men are at higher risk than women for escalation to high-dose opioid therapy and death from opioid-related causes. Both outcomes were more common than anticipated.

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