Correlates of Prescription Opioid Initiation and Long-term Opioid Use in Veterans With Persistent Pain
Correlates of Prescription Opioid Initiation and Long-term Opioid Use in Veterans With Persistent Pain
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DOI：
10.1097/ajp.0b013e3182490bdb
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发表时间：
2013-02-01
影响因子：
2.9
通讯作者：
Deyo, Richard A.
中科院分区：
文献类型：
--
作者：
Dobscha, Steven K.;Morasco, Benjamin J.;Deyo, Richard A.
目的：关于如何启动阿片类药物处方治疗慢性疼痛知之甚少。我们试图描述处方阿片类药物启动的模式，确定阿片类药物启动的相关性，并检查相关的长期阿片类药物治疗（COT）的退伍军人与持续性noncancer pain.Methods：使用退伍军人事务部的行政数据，我们确定了5961退伍军人从太平洋西北部的持续升高的疼痛强度评分谁没有规定阿片类药物在过去的12个月。我们比较了退伍军人没有处方阿片类药物在随后的12个月与那些规定的任何阿片类药物和那些规定的COT（> 90连续days）。结果：在研究年，35%的样本收到阿片类药物处方和5%收到COT。大多数第一次阿片类药物处方是由初级保健临床医生开具的。与其他两组的退伍军人相比，使用COT的退伍军人更年轻，疼痛强度更大，精神和物质使用障碍的发生率更高。在接受COT的患者中，29%的患者处方了长效阿片类药物，37%的患者接受了1次或多次尿液药物筛查，24%的患者处方了苯二氮卓类药物。校正年龄、性别和基线疼痛强度后，重度抑郁症[比值比1.24（1.10-1.39）; 1.48（1.14-1.93）]和尼古丁依赖[1.34（1.17-1.53）; 2.02（1.53-2.67）]分别与接受任何阿片类药物处方和COT相关。阿片类药物在患有持续性疼痛的退伍军人中很常见，但大多数退伍军人并没有长期服用阿片类药物。精神疾病和物质使用障碍与接受COT相关。许多接受COT的退伍军人同时接受苯二氮卓类药物处方，许多人不接受尿液药物筛查;需要进行关于优化COT在该人群中安全性的实践的额外研究。
Objectives: Little is known about how opioid prescriptions for chronic pain are initiated. We sought to describe patterns of prescription opioid initiation, identify correlates of opioid initiation, and examine correlates of receipt of chronic opioid therapy (COT) among veterans with persistent noncancer pain.Methods: Using Veterans Affairs administrative data, we identified 5961 veterans from the Pacific Northwest with persistent elevated pain intensity scores who had not been prescribed opioids in the prior 12 months. We compared veterans not prescribed opioids over the subsequent 12 months with those prescribed any opioid and to those prescribed COT (> 90 consecutive days).Results: During the study year, 35% of the sample received an opioid prescription and 5% received COT. Most first opioid prescriptions were written by primary care clinicians. Veterans prescribed COT were younger, had greater pain intensity, and high rates of psychiatric and substance use disorders compared with veterans in the other 2 groups. Among patients receiving COT, 29% were prescribed long-acting opioids, 37% received 1 or more urine drug screens, and 24% were prescribed benzodiazepines. Adjusting for age, sex, and baseline pain intensity, major depression [odds ratio 1.24 (1.10-1.39); 1.48 (1.14-1.93)], and nicotine dependence [1.34 (1.17-1.53); 2.02 (1.53-2.67)] were associated with receiving any opioid prescription and with COT, respectively.Discussion: Opioid initiations are common among veterans with persistent pain, but most veterans are not prescribed opioids long-term. Psychiatric disorders and substance use disorders are associated with receiving COT. Many Veterans receiving COT are concurrently prescribed benzodiazepines and many do not receive urine drug screening; additional study regarding practices that optimize safety of COT in this population is indicated.