Risk factors for drug dependence among out-patients on opioid therapy in a large US health-care system
Risk factors for drug dependence among out-patients on opioid therapy in a large US health-care system
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DOI：
10.1111/j.1360-0443.2010.03052.x
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发表时间：
2010-10-01
期刊：
影响因子：
6
通讯作者：
Stewart, Walter F.
中科院分区：
文献类型：
--
作者：
Boscarino, Joseph A.;Rukstalis, Margaret;Stewart, Walter F.
AimsOur研究旨在评估阿片类药物依赖的患病率和风险因素在门诊患者长期阿片类药物治疗在一个大型health-care system.MethodsUsing电子健康记录，我们确定了门诊患者接受4+医生的阿片类药物治疗的订单在过去的12个月内的非癌症疼痛在一个大型的美国卫生保健系统。我们完成了诊断访谈705这些患者，以确定阿片类药物使用障碍和评估的危险factors.ResultsPreliminary分析表明，目前阿片类药物依赖可能高达26% [95%置信区间（CI）= 22.0-29.9]的患者研究。Logistic回归分析显示，当前依赖与病历中常见的变量有关，包括年龄< 65岁[OR = 2.33，P = 0.001]，阿片类药物滥用史（OR = 3.81，P < 0.001）、高依赖程度（OR = 1.85，P = 0.001）、重性抑郁（OR = 1.29，P = 0.022）和精神药物使用（OR = 1.73，P = 0.006）。年龄、抑郁、精神药物和疼痛损害四个变量联合预测当前依赖的风险增加，与没有这些因素的人相比（OR = 8.01，P < 0.001）。了解患者也有严重依赖和阿片类药物滥用的历史大大增加了这种风险（OR = 56.36，P < 0.001）。少数因素，许多记录在病历中，预测阿片类药物依赖的门诊患者研究。这些初步研究结果将有助于今后的研究工作。
AimsOur study sought to assess the prevalence of and risk factors for opioid drug dependence among out-patients on long-term opioid therapy in a large health-care system.MethodsUsing electronic health records, we identified out-patients receiving 4+ physician orders for opioid therapy in the past 12 months for non-cancer pain within a large US health-care system. We completed diagnostic interviews with 705 of these patients to identify opioid use disorders and assess risk factors.ResultsPreliminary analyses suggested that current opioid dependence might be as high as 26% [95% confidence interval (CI) = 22.0-29.9] among the patients studied. Logistic regressions indicated that current dependence was associated with variables often in the medical record, including age < 65 [odds ratio (OR) = 2.33, P = 0.001], opioid abuse history (OR = 3.81, P < 0.001), high dependence severity (OR = 1.85, P = 0.001), major depression (OR = 1.29, P = 0.022) and psychotropic medication use (OR = 1.73, P = 0.006). Four variables combined (age, depression, psychotropic medications and pain impairment) predicted increased risk for current dependence, compared to those without these factors (OR = 8.01, P < 0.001). Knowing that the patient also had a history of severe dependence and opioid abuse increased this risk substantially (OR = 56.36, P < 0.001).ConclusionOpioid misuse and dependence among prescription opioid patients in the United States may be higher than expected. A small number of factors, many documented in the medical record, predicted opioid dependence among the out-patients studied. These preliminary findings should be useful in future research efforts.