Pharmacoepidemiologic analyses of opioid use among OEF/OIF/OND veterans.
Pharmacoepidemiologic analyses of opioid use among OEF/OIF/OND veterans.
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DOI：
10.1097/j.pain.0000000000000874
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发表时间：
2017-06
期刊：
影响因子：
7.4
通讯作者：
Edlund MJ
中科院分区：
文献类型：
--
作者：
Hudson TJ;Painter JT;Martin BC;Austen MA;Williams JS;Fortney JC;Sullivan MD;Edlund MJ
药物流行病学分析发现，OEF/OIF/OND退伍军人阿片类药物使用率较高，具有剂量强度适中、疗程长的特点。退伍军人中使用阿片类药物非常令人担忧，特别是那些曾在阿富汗(OEF)和伊拉克(OIF和OND)服役的退伍军人。本研究提供了09财年至2012财年OEF/OIF/OND退伍军人中阿片类药物使用的详细药物流行病学分析。来自退伍军人健康管理局(VHA)的3个数据库的数据被用来描述与OEF/OIF/OND退伍军人和脑外伤患者的阿片类药物使用相关的人口统计学、临床和药物特征。在2012财年，使用Logistic回归模型来确定与长期使用阿片类药物相关的风险。大约23%的OEF/OIF/OND退伍军人和35%的TBI患者接受了任何阿片类药物治疗。大多数人每天接受中等剂量的吗啡相当于26至30毫克不等。所有OEF/OIF/OND退伍军人使用阿片类药物的中位数为30至40天。两组中与慢性使用相关的因素包括年轻、男性、白人、已婚和生活在农村地区。诊断为创伤后应激障碍(优势比[OR]=1.22，P<；0.0001)、严重抑郁障碍(OR=1.14，P<；0.0001)和烟草使用障碍(OR=1.18，P<；0.0001)与长期使用阿片类药物密切相关。背痛也与长期使用密切相关(OR=2.5，P<；0.0001)。随着疼痛严重程度的增加，慢性阿片类药物使用的几率也增加：轻度疼痛(OR=3.76P<；0.0001)、中度疼痛(OR=6.8，P<；0.0001)和重度疼痛(OR=8.49P<；0.0001)。OEF/OIF/OND退伍军人使用阿片类药物的特点是中等剂量，少数退伍军人在相对较长的时间内使用。
Pharmacoepidemiologic analysis found that OEF/OIF/OND veterans have high rates of opioid use, characterized by moderate dose intensity and long treatment duration. There is a great deal of concern about opioid use in veterans, particularly those who served in Afghanistan (OEF) and Iraq (OIF and OND). The current study provides a detailed pharmacoepidemiologic analysis of opioid use among OEF/OIF/OND veterans from FY09 to FY12. Data from 3 data repositories from the Veterans Health Administration (VHA) were used to describe demographic, clinical, and medication characteristics associated with opioid use among OEF/OIF/OND veterans and among those with TBI. Logistic regression models were used to identify risks associated with chronic opioid use in FY12. Approximately 23% of all OEF/OIF/OND veterans and 35% of those with TBI received any opioid medications. Most received moderate doses ranging from 26 to 30 mg morphine equivalent dose daily. Median days of opioid use for all OEF/OIF/OND veterans were 30 to 40 days. Factors associated with chronic use in both groups included young age, male sex, white race, being married, and living in rural areas. A diagnosis of PTSD (odds ratio [OR] = 1.22, P < 0.0001), major depressive disorder (OR = 1.14, P < 0.0001), and tobacco use disorder (OR = 1.18, P < 0.0001) were strongly associated with chronic opioid use. Back pain was also strongly associated with chronic use (OR = 2.50, P < 0.0001). As pain severity increased the odds of chronic opioid use also increased: mild pain (OR = 3.76, P < 0.0001), moderate pain (OR = 6.80, P < 0.0001), and severe pain (OR = 8.49, P < 0.0001). Opioid use among OEF/OIF/OND veterans is characterized by moderate doses that are used over relatively long periods of time by a minority of veterans.