Polysubstance use and association with opioid use disorder treatment in the US Veterans Health Administration
Polysubstance use and association with opioid use disorder treatment in the US Veterans Health Administration
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DOI：
10.1111/add.15116
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发表时间：
2020-07-07
期刊：
影响因子：
6
通讯作者：
Ilgen, Mark A.
中科院分区：
文献类型：
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作者：
Lin, Lewei A.;Bohnert, Amy S. B.;Ilgen, Mark A.
为了了解共病物质使用障碍（SUD）或多种物质使用在阿片类药物使用障碍（OUD）治疗中的作用，本研究将OUD患者与其他SUD患者进行了比较，并检查了与OUD治疗的相关性。设计、设置和参与者回顾性国家队列研究，研究对象为2017财政年度（FY）接受美国退伍军人健康管理局（VHA）治疗的诊断为OUD的退伍军人（n = 65 741）。比较了仅诊断为OUD与诊断为另一种SUD（OUD + 1 SUD）和多个SUD（OUD + >= 2 SUD）的患者的特征。该研究检查了1年随访期间共病SUD与接受丁丙诺啡、美沙酮和SUD门诊治疗之间的关系，并根据患者人口统计学特征和临床状况进行了调整。在2017财年的65741名OUD退伍军人中，41.2%仅患有OUD，22.9%患有OUD + 1 SUD，35.9%患有OUD + >= 2 SUD。常见的共病SUD包括酒精使用障碍（41.3%）、可卡因/兴奋剂使用障碍（30.0%）和大麻使用障碍（22.4%）。调整患者特征后，OUD + 1 SUD患者[调整后的比值比（aOR）= 0.87，95%置信区间（CI）= 0.82-0.93]和OUD +>= 2 SUD患者（aOR = 0.65，95% CI = 0.61-0.69）与仅OUD患者相比，接受丁丙诺啡的几率较低。OUD + 1 SUD患者（aOR = 0.91，95%CI = 0.86-0.97）和OUD + >= 2 SUD患者（aOR = 0.79，95%CI = 0.74-0.84）接受美沙酮治疗的几率也较低。OUD + 1 SUD患者（aOR = 1.85，95% CI = 1.77-1.93）和OUD + >= 2 SUD患者（aOR = 3.25，95% CI = 3.103.41）更有可能进行SUD门诊访视。结论：美国退伍军人健康管理局诊断为阿片类药物使用障碍的大多数退伍军人似乎至少有一种共病物质使用障碍，许多人有多种物质使用障碍。尽管物质使用障碍门诊就诊的可能性较高，但患有非阿片类物质使用障碍与丁丙诺啡治疗的可能性较低相关，这表明在扩大阿片类物质使用障碍治疗的努力中解决多种物质使用的重要性。
Aims To understand the role of comorbid substance use disorders (SUDs), or polysubstance use, in the treatment of opioid use disorder (OUD), this study compared patients with OUD only to those with additional SUDs and examined association with OUD treatment receipt. Design, setting and participants Retrospective national cohort study of Veterans diagnosed with OUD (n = 65 741) receiving care from the US Veterans Health Administration (VHA) in fiscal year (FY) 2017. Measurements Patient characteristics were compared among those diagnosed with OUD only versus those with one other SUD (OUD + 1 SUD) and with multiple SUDs (OUD + >= 2 SUDs). The study examined the relationship between comorbid SUDs and receipt of buprenorphine, methadone and SUD outpatient treatment during 1-year follow-up, adjusting for patient demographic characteristics and clinical conditions. Findings Among the 65 741 Veterans with OUD in FY 2017, 41.2% had OUD only, 22.9% had OUD + 1 SUD and 35.9% had OUD + >= 2 SUDs. Common comorbid SUDs included alcohol use disorder (41.3%), cocaine/stimulant use disorder (30.0%) and cannabis use disorder (22.4%). Adjusting for patient characteristics, patients with OUD + 1 SUD [adjusted odds ratio (aOR) = 0.87, 95% confidence interval (CI) = 0.82-0.93] and patients with OUD +>= 2 SUDs(aOR = 0.65, 95% CI = 0.61-0.69) had lower odds of receiving buprenorphine compared with OUD only patients. There were also lower odds of receiving methadone for patients with OUD + 1 SUD (aOR = 0.91, 95% CI = 0.86-0.97)and for those with OUD + >= 2 SUDs(aOR = 0.79, 95% CI = 0.74-0.84). Patients with OUD + 1 SUD (aOR = 1.85, 95% CI = 1.77-1.93) and patients with OUD + >= 2 SUDs(aOR = 3.25, 95% CI = 3.103.41) were much more likely to have a SUD clinic visit. Conclusions The majority of Veterans in the US Veterans Health Administration diagnosed with opioid use disorder appeared to have at least one comorbid substance use disorder and many have multiple substance use disorders. Despite the higher likelihood of a substance use disorder clinic visit, having a non-opioid substance use disorder is associated with lower likelihood of buprenorphine treatment, suggesting the importance of addressing polysubstance use within efforts to expand treatment for opioid use disorder.