长期阿片类药物治疗的退伍军人的物质使用和使用障碍

IF 2.9

Drug and alcohol dependence reports Pub Date : 2025-05-19 DOI:10.1016/j.dadr.2025.100347

Thye Peng Ngo , Salomeh Keyhani , Samuel Leonard , Katherine J. Hoggatt

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引用次数: 0

摘要

背景很少有研究报道使用长期阿片类药物治疗（LTOT）的退伍军人中物质使用和物质使用障碍（SU/SUD）的患病率和健康风险。我们利用健康记录数据来估计SU/SUD患病率及其与LTOT退伍军人死亡率的关系。方法对2014-2019年退伍军人健康管理局门诊门诊退伍军人LTOT队列数据进行二次分析。SU/SUD被定义为危险饮酒的阳性筛查；尿液中大麻、苯二氮卓类药物或兴奋剂呈阳性；或有记录的SUD诊断。我们拟合全因死亡率、致死性用药过量和创伤性死亡的Cox模型，比较LTOT联合SU/SUD治疗的退伍军人与仅LTOT治疗的退伍军人。结果四分之一（25.0%）的LTOT退伍军人有危险的酒精使用，其他物质检测呈阳性，或诊断为SUD。酒精是最常见的SU/SUD(9.8%)，其次是镇静剂（8.1%）、大麻（6.6%）和兴奋剂（0.6%）。与仅使用LTOT的退伍军人相比，使用LTOT的退伍军人的死亡率更高，大麻（HR=1.16, 95% CI=1.03, 1.30）、镇静剂（HR=1.29, 95% CI=1.10, 1.52）或兴奋剂SU/SUD （HR=1.54, 95% CI=1.17, 2.02）。酒精（HR=1.43, 95% CI=1.10, 1.86）、镇静剂（HR=1.40, 95% CI=1.04, 1.91）或兴奋剂SU/SUD （HR=3.29, 95% CI=1.60, 6.77）的LTOT致死过量率较高。LTOT合并镇静SU/SUD与创伤性死亡率相关（HR=1.30, 95% CI=1.05, 1.61）。结论药物共同使用在LTOT退伍军人中很常见，并与死亡率升高和用药过量风险相关。可能需要全面筛查和有针对性的干预措施。

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Substance use and use disorders among Veterans on long-term opioid therapy

Background

Few studies have reported on the prevalence and health risks associated with substance use and substance use disorder (SU/SUD) in Veterans who use long-term opioid therapy (LTOT). We leveraged health record data to estimate SU/SUD prevalence and its association with mortality among Veterans on LTOT.

Methods

We conducted a secondary analysis of cohort data for Veterans on LTOT within Veterans Health Administration outpatient settings (2014–2019). SU/SUD was defined as a positive screen for risky alcohol use; a positive urine drug screen for cannabis, benzodiazepines, or stimulants; or a documented SUD diagnosis. We fit Cox models for all-cause mortality, fatal overdose, and traumatic deaths, comparing Veterans on LTOT with SU/SUD vs. LTOT-only.

Results

One in four (25.0 %) Veterans on LTOT have risky alcohol use, tested positive for other substances, or had a diagnosed SUD. Alcohol was the most common SU/SUD (9.8 %), followed by sedative (8.1 %), cannabis (6.6 %), and stimulant (0.6 %). Relative to Veterans on LTOT only, mortality rates were higher for Veterans on LTOT with cannabis (HR=1.16, 95 % CI=1.03, 1.30), sedative (HR=1.29, 95 % CI=1.10, 1.52), or stimulant SU/SUD (HR=1.54, 95 % CI=1.17, 2.02). Fatal overdose rates were higher for LTOT with alcohol (HR=1.43, 95 % CI=1.10, 1.86), sedatives (HR=1.40, 95 % CI=1.04, 1.91), or stimulant SU/SUD (HR=3.29, 95 % CI=1.60, 6.77). LTOT with sedative SU/SUD was associated with traumatic death rates (HR=1.30, 95 % CI=1.05, 1.61).

Conclusion

Substance co-use is common among Veterans on LTOT and is associated with elevated mortality and overdose risks. Comprehensive screening and targeted interventions may be needed.

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来源期刊

Drug and alcohol dependence reports Psychiatry and Mental Health

自引率

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审稿时长

100 days