为了应对美国的阿片类药物危机，阿片类药物的人口处方量一直在减少；然而，有人担心剂量减少与潜在的不良事件有关。检查阿片类药物剂量减少与 1 个月潜在不良事件风险之间的关联（急诊科 (ED) 就诊、阿片类药物过量、苯二氮卓类药物处方配药、全因死亡率） ）。这项观察性队列研究使用了美国八个卫生系统处方阿片类药物登记处的电子健康记录和索赔数据（临床试验网络-0084）。 2012 年 1 月 1 日至 2018 年 12 月 31 日之间的所有阿片类药物填充（不包括丁丙诺啡）均用于确定连续六个月内每日平均吗啡毫克当量  ≥ 50 毫克当量的基线期。我们确定了 60,040 名患有 ≥ 1 的非癌症患者2 个月的剂量减少期（600,234 个独特的剂量减少期）。分析检查了剂量减少水平（2 个月内 1- < 15%、15- < 30%、30- < 100%、100%）与潜在不良事件之间的关联使用逻辑回归分析调整剂量减少后的一个月，根据患者特征进行调整。总体而言，剂量减少期平均减少 18.7%。与减少 1- < 15% 相比，剂量减少 30- < 100% 与较高的急诊就诊几率（OR 1.14，95% CI 1.10，1.17）、阿片类药物过量（OR 1.41，95% CI 1.09-1.81）相关）和全因死亡率（OR 1.39，95% CI 1.16-1.67），但补充苯二氮卓类药物的几率较低（OR 0.83，95% CI 0.81-0.85）。与1- < 15%相比，剂量减少15- < 30%与较高的急诊就诊几率（OR 1.08，95% CI 1.05-1.11）和较低的苯二氮卓类药物填充几率相关（OR 0.93，95% CI 0.92-0.95），但与阿片类药物过量和全因死亡率无关。阿片类药物治疗患者的大幅减少可能会增加减少后一个月发生潜在不良事件的风险，应仔细监测。© 2023。作者），经普通内科医学会独家许可。

In response to the opioid crisis in the United States, population-level prescribing of opioids has been decreasing; there are concerns, however, that dose reductions are related to potential adverse events.Examine associations between opioid dose reductions and risk of 1-month potential adverse events (emergency department (ED) visits, opioid overdose, benzodiazepine prescription fill, all-cause mortality).This observational cohort study used electronic health record and claims data from eight United States health systems in a prescription opioid registry (Clinical Trials Network-0084). All opioid fills (excluding buprenorphine) between 1/1/2012 and 12/31/2018 were used to identify baseline periods with mean morphine milligram equivalents daily dose of  ≥ 50 during six consecutive months.We identified 60,040 non-cancer patients with  ≥ one 2-month dose reduction period (600,234 unique dose reduction periods).Analyses examined associations between dose reduction levels (1- < 15%, 15- < 30%, 30- < 100%, 100% over 2 months) and potential adverse events in the month following a dose reduction using logistic regression analysis, adjusting for patient characteristics.Overall, dose reduction periods involved mean reductions of 18.7%. Compared to reductions of 1- < 15%, dose reductions of 30- < 100% were associated with higher odds of ED visits (OR 1.14, 95% CI 1.10, 1.17), opioid overdose (OR 1.41, 95% CI 1.09-1.81), and all-cause mortality (OR 1.39, 95% CI 1.16-1.67), but lower odds of a benzodiazepine fill (OR 0.83, 95% CI 0.81-0.85). Dose reductions of 15- < 30%, compared to 1- < 15%, were associated with higher odds of ED visits (OR 1.08, 95% CI 1.05-1.11) and lower odds of a benzodiazepine fill (OR 0.93, 95% CI 0.92-0.95), but were not associated with opioid overdose and all-cause mortality.Larger reductions for patients on opioid therapy may raise risk of potential adverse events in the month after reduction and should be carefully monitored.© 2023. The Author(s), under exclusive licence to Society of General Internal Medicine.