Pain Medication Prescriptions and Misuse Following Treatment for Alcohol Use Disorders

酒精使用障碍治疗后的止痛药处方和滥用

• 批准号: 10201106
• 负责人: PETER L. ELKIN
• 金额: $ 36.07万
• 依托单位: STATE UNIVERSITY OF NEW YORK AT BUFFALO
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-01 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10201106
• 关键词: Accidents; Acute; Acute Pain; Address; Adherence; Admission activity; Adult; Adverse event; Age; Alcohol abuse; Alcohol consumption; Alcohol dependence; Alcohol or Other Drugs use; Alcoholism; Alcohols; Analgesics; Benzodiazepines; Cessation of life; Chronic; Client; Clinical; Data; Data Set; Databases; Diagnosis; Disease; Dose; Dropout; Drug usage; Exhibits; Failure; Family history of; Feeling; Goals; Health; Individual; Information Systems; Injury; Lead; Link; Medicaid; Medical; Mental disorders; Morbidity - disease rate; Motivation; Nature; New York; Opioid; Overdose; Pain; Patients; Pharmaceutical Preparations; Pharmacotherapy; Physicians; Population; Prevalence; Primary Health Care; Property; Recording of previous events; Records; Regimen; Relapse; Reporting; Risk; Sampling; Series; Services; Substance Use Disorder; Substance abuse problem; System; Testing; Time; Treatment Factor; Update; Violence; adverse outcome; alcohol abuse therapy; alcohol availability; alcohol involvement; alcohol use disorder; chronic alcohol ingestion; chronic pain; drug misuse; emotional abuse; experience; high risk; misuse of prescription only drugs; mortality; neural circuit; opioid misuse; physical abuse; policy implication; prescription opioid; problem drinker; relapse prediction; treatment program; treatment services

Abstract There are critical links between alcohol use disorder (AUD) and pain that have been largely ignored until recently. For example, individuals with alcohol dependence often experience physical injuries from accidents and violence that have a lasting physical impact. Chronic alcohol use can also lead to physical conditions that produce significant pain. Similarly, AUDs can also lead to poor adherence to medical regimens for diseases which can result in exacerbation in pain. Finally, given that common neural circuits are impacted by chronic pain and by alcohol dependence, alcohol dependence may lead to heightened feelings of pain, and that such pain may lead to alcohol use for its analgesic properties. Given these linkages between AUDs and chronic pain, it is not surprising to find significant proportions of individuals with AUD report that they experience significant pain and are in treatment for chronic pain. The presence of chronic pain among individuals with AUD, combined with the chronic, relapsing nature of alcohol use disorders raises the possibility that individuals with an alcohol use disorder may seek treatment for chronic pain, receive opioid and/or benzodiazepine prescriptions for pain, and be at risk for morbidity and mortality associated with using these medications, particularly in conjunction with excessive alcohol use. This study proposes to integrate records from the Client Data System of the New York State Office of Alcoholism and Substance Abuse Services (OASAS) patient records with New York State Medicaid records. We plan to identify approximately 214,000 Medicaid patients with a first contact with the OASAS treatment system from 2006-2014 and merge these treatment records with their Medicaid claims records from their initial treatment contact through 2015. In addition, we will draw a sample three times as large of matched individuals from the Medicaid claims to serve as a comparison sample. Hypotheses will address the extent to which individuals with a history of treatment for alcohol problems are at increased risk for receiving prescriptions for opioids and benzodiazepine for pain and whether this is because of an increased risk of pain diagnoses, or whether this risk remains after controlling for diagnoses. We will also determine if alcohol treatment patients are at further risk for higher doses, longer durations, and misuse/overdose from these substances, and whether pain diagnoses account for this risk. Moreover, the integration of these datasets will allow us to identify factors in the existing treatment records that would identify individuals most at risk for the excessive use and misuse of these medications. These findings will have important clinical implications for the management of patients in primary care with an unrecognized history of an alcohol use disorder and policy implications with respect to medical access to alcohol treatment records.

抽象的 酒精使用障碍 (AUD) 和疼痛之间存在重要联系，但直到现在，这些联系在很大程度上都被忽视了。 最近。例如，酒精依赖者经常会因事故而遭受身体伤害 以及对身体造成持久影响的暴力。长期饮酒也会导致身体状况 产生明显的疼痛。同样，AUD 也会导致疾病治疗的依从性较差 这可能会导致疼痛加剧。最后，考虑到常见的神经回路受到慢性病的影响 疼痛和酒精依赖，酒精依赖可能会导致疼痛感加剧，并且这种情况 疼痛可能会导致饮酒，因为它具有镇痛作用。鉴于澳元与慢性病之间的这些联系 痛苦，毫不奇怪地发现很大一部分患有 AUD 的人报告说他们经历过 严重疼痛并正在治疗慢性疼痛。患有慢性疼痛的个体存在 AUD，加上酒精使用障碍的慢性、复发性，增加了个体以下可能性： 患有酒精使用障碍的人可能会寻求慢性疼痛的治疗，接受阿片类药物和/或苯二氮卓类药物 治疗疼痛的处方，并面临与使用这些药物相关的发病率和死亡风险， 特别是与过量饮酒有关。本研究建议整合客户的记录 纽约州酗酒和药物滥用服务办公室 (OASAS) 患者数据系统 记录与纽约州医疗补助记录。我们计划识别大约 214,000 名医疗补助患者 2006-2014 年首次接触 OASAS 治疗系统，并将这些治疗记录与 他们从最初接触治疗到 2015 年的医疗补助索赔记录。此外，我们将绘制一份 从医疗补助声称中抽取三倍大的匹配个体作为比较样本。 假设将解决有酗酒问题治疗史的个体在多大程度上处于酒精问题的状态。 接受阿片类药物和苯二氮卓类止痛处方的风险增加，这是否是因为 疼痛诊断的风险增加，或者在控制诊断后这种风险是否仍然存在。我们还将 确定酒精治疗患者是否因更高剂量、更长持续时间而面临进一步风险，以及 这些物质的误用/过量，以及疼痛诊断是否会导致这种风险。此外， 这些数据集的整合将使我们能够识别现有治疗记录中的因素，从而确定 最有可能过度使用和滥用这些药物的人。这些发现将有 对于初级保健中具有未识别病史的患者的管理具有重要的临床意义 酒精使用障碍以及对酒精治疗记录的医疗获取的政策影响。