Non-medical use of prescription opioids is associated with heroin initiation among US veterans: a prospective cohort study
Non-medical use of prescription opioids is associated with heroin initiation among US veterans: a prospective cohort study
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DOI：
10.1111/add.13491
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发表时间：
2016-11-01
期刊：
影响因子：
6
通讯作者：
Marshall, Brandon D. L.
中科院分区：
文献类型：
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作者：
Banerjee, Geetanjoli;Edelman, E. Jennifer;Marshall, Brandon D. L.
目的评估非医疗使用处方阿片类药物(NMUPO)对接受医疗护理的美国退伍军人中海洛因产生的影响。设计采用多变量Cox回归模型，分析来自美国艾滋病毒感染的前瞻性、多地点观察性研究和年龄/种族/地点匹配的未感染艾滋病毒的退伍军人对照组的数据。大约每年进行一次行为评估，其中包含对NMUPO和海洛因使用的自我报告测量。设置退伍军人健康管理局(VHA)传染病和初级保健诊所，分布在亚特兰大、巴尔的摩、纽约、休斯顿、洛杉矶、匹兹堡和华盛顿特区参与研究的3396名艾滋病毒感染和未感染的患者登记在退伍军人老龄化队列研究中，他们报告终身未使用NMUPO或海洛因，基线没有阿片类药物使用障碍诊断，并在2002至2012年间进行跟踪。测量的主要结果测量是自我报告的海洛因使用事件，主要感兴趣的暴露是新发病的NMUPO。我们的最终模型调整了社会人口学、疼痛干扰、既往创伤后应激障碍和/或抑郁症的诊断以及自我报告的其他药物使用。结果使用多变量Cox回归模型，我们发现非药物使用处方阿片类药物NMUPO与海洛因起始独立正相关[调整后的危险比(AHR)=5.43，95%可信区间(CI)=4.01，7.35]。结论首次非医疗使用处方阿片类药物(NMUPO)是美国HIV感染者和未感染的退伍军人中海洛因起始的强烈危险因素，他们以前没有报告过NMUPO或非法阿片类药物使用史。
AimsTo estimate the influence of non-medical use of prescription opioids (NMUPO) on heroin initiation among US veterans receiving medical care.DesignUsing a multivariable Cox regression model, we analyzed data from a prospective, multi-site, observational study of HIV-infected and an age/race/site-matched control group of HIV-uninfected veterans in care in the United States. Approximately annual behavioral assessments were conducted and contained self-reported measures of NMUPO and heroin use.SettingVeterans Health Administration (VHA) infectious disease and primary care clinics in Atlanta, Baltimore, New York, Houston, Los Angeles, Pittsburgh and Washington, DC.ParticipantsA total of 3396 HIV-infected and uninfected patients enrolled into the Veterans Aging Cohort Study who reported no life-time NMUPO or heroin use, had no opioid use disorder diagnoses at baseline and who were followed between 2002 and 2012.MeasurementsThe primary outcome measure was self-reported incident heroin use and the primary exposure of interest was new-onset NMUPO. Our final model was adjusted for socio-demographics, pain interference, prior diagnoses of post-traumatic stress disorder and/or depression and self-reported other substance use.FindingsUsing a multivariable Cox regression model, we found that non-medical use of prescription opioids NMUPO was associated positively and independently with heroin initiation [adjusted hazard ratio (AHR)=5.43, 95% confidence interval (CI)=4.01, 7.35].ConclusionsNew-onset non-medical use of prescription opioids (NMUPO) is a strong risk factor for heroin initiation among HIV-infected and uninfected veterans in the United States who reported no previous history of NMUPO or illicit opioid use.