A Retrospective 4-year Outcome Study of Veterans Admitted to an Acute Inpatient Detoxification Unit for Opioid Use Disorder
A Retrospective 4-year Outcome Study of Veterans Admitted to an Acute Inpatient Detoxification Unit for Opioid Use Disorder
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DOI：
10.1111/ajad.12893
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发表时间：
2019-07-01
影响因子：
3.7
通讯作者：
DeLisi, Lynn E.
中科院分区：
文献类型：
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作者：
Li, Kevin J.;Smedberg, Diane L.;DeLisi, Lynn E.
背景和目标 2017 年，阿片类药物相关死亡人数为 47 600 人，年死亡人数已超过艾滋病毒/艾滋病年死亡率峰值。住院康复（RR）和药物辅助治疗（MAT）是阿片类药物使用障碍（OUD）的常用治疗方法。方法 纳入 2015 年因医疗监督下阿片类药物戒断而入住波士顿退伍军人健康管理局住院的所有患者 (n = 182)。根据年龄和性别，已故患者与 182 名患者队列中的活着患者进行 1:1 匹配。对 2015 年至 2018 年的全国电子病历进行了分析。通过多元线性回归，风险因素与全因死亡率（因变量）的相关性是我们的主要结果。主要危险因素包括因医学监督下的停药而反复入院以及接触 RR 或 MAT。次要风险因素是阿片类药物使用特征、非阿片类药物使用、伴侣支持、教育水平、无家可归和就业。结果 18.4% (n = 34) 在随访时死亡，相当于每 10 万人年有 4760 人死亡。总共 61.8% (n = 21) 的死亡与阿片类药物的使用直接相关。 RR 的完成与较低的预测死亡率相关（β = -8.21，P = 0.03）。相反，参加 RR 但未完成与较高的预测死亡率相关（β = 6.51，P = 0.046）。同时使用苯二氮卓类药物（β = 8.99，P = 0.047）、广泛性焦虑症（β = 7.13，P = 0.03）和重度抑郁症（β = 5.44，P = 0.04）会增加死亡风险。结论和科学意义 OUD 对因阿片类药物戒断而需要住院治疗的退伍军人具有惊人的高致死率，特别是当存在未经治疗的共病精神疾病时。 RR 和 MAT 与该人群较低的全因死亡率相关，应高度利用。鉴于死亡率极高，需要采取密集的全系统干预措施来护理患有 OUD 的退伍军人。在 RR 和 MAT 降低预测死亡率的基础上，进一步研究新型 MAT 以及完善 RR 计划应成为主要重点。 （Am J Addict 2019；28：318-323）
Background and Objectives With 47 600 opioid-related deaths in 2017, the yearly deaths have surpassed the HIV/AIDS peak yearly death rates. Residential rehabilitation (RR) and medication-assisted treatments (MAT) are commonly utilized treatments for opioid use disorder (OUD). Methods All patients (n = 182) who were admitted to the Boston Veterans Health Administration for inpatient admission for medically supervised opioid withdrawal in 2015 were included. Deceased patients were matched 1:1, based on age and sex to living patients from the 182-patient cohort. Nationwide electronic medical records were analyzed from 2015 through 2018. Via multilinear regression, risk factor correlation to all-cause mortality (the dependent variable) was our main outcome. Primary risk factors included recurrent admissions for medically supervised withdrawals and exposure to RR or MAT. Secondary risk factors were opioid use traits, nonopioid drug use, partner support, education level, homelessness, and employment. Results 18.4% (n = 34) were deceased by the time of follow-up-equivalent to 4760 deaths per 100 000 person-years. A total of 61.8% (n = 21) of these deaths were directly related to opioid use. Completion of RR correlated with lower predicted mortality (beta = -8.21, P = 0.03). In contrast, attending RR but not completing correlated with higher predicted mortality rate (beta = 6.51, P = 0.046). Concurrent benzodiazepine use (beta = 8.99, P = 0.047), generalized anxiety disorder (beta = 7.13, P = 0.03) and major depressive disorder (beta = 5.44, P = 0.04) increased risk of death. Conclusion and Scientific Significance OUD carries a shockingly high lethality in Veterans requiring inpatient admission for opioid withdrawal, particularly when there are untreated comorbid psychiatric conditions. RR and MAT are correlated to lower all-cause mortality in this population and should be highly utilized. Given the extremely high mortality, intensive system-wide interventions are needed for the care of Veterans with OUD. On the basis of the reduced predicted mortality with RR and MAT, further research into novel MATs as well as refining RR programs should be a major focus. (Am J Addict 2019;28:318-323)