Pain Medication Prescriptions and Misuse Following Treatment for Alcohol Use Disorders

摘要 酒精使用障碍(AUD)和疼痛之间的关键联系在很大程度上被忽视了，直到 最近。例如，有酒精依赖的人经常会在事故中遭受身体伤害 以及对身体产生持久影响的暴力。长期饮酒也会导致身体状况 会产生巨大的痛苦。同样，急性尿毒症也可能导致对疾病药物治疗方案的依从性较差。 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疾病的影响 由于疼痛和酒精依赖，酒精依赖可能会导致痛感增强，而这种情况 疼痛可能会导致饮酒，因为它有止痛的特性。鉴于AUDS和慢性病之间的这些联系 疼痛，这并不令人惊讶，发现有相当比例的AUD患者报告说他们经历过 严重疼痛，正在接受慢性疼痛的治疗。患有慢性疼痛的个体中存在的 AUD，结合酒精使用障碍的慢性、复发性，增加了个体 有酒精使用障碍的人可以寻求治疗慢性疼痛，接受阿片类药物和/或苯二氮类药物 止痛药，并面临与使用这些药物相关的发病率和死亡率的风险， 尤其是在过度饮酒的情况下。这项研究建议整合来自客户端的记录 纽约州酒精中毒和药物滥用服务办公室(OASAS)患者数据系统 与纽约州医疗补助记录一致。我们计划确定大约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 他们的医疗补助索赔记录从他们的第一次治疗接触到2015年。此外，我们还将绘制一个 来自医疗补助计划的三倍大的匹配个人样本声称作为比较样本。 假说将解决有酒精问题治疗史的个人在多大程度上 接受阿片类药物和苯二氮卓类止痛药处方的风险增加，以及这是否因为 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面临更高剂量、更长持续时间和 这些物质的滥用/过量，以及疼痛诊断是否说明了这一风险。此外， 整合这些数据集将使我们能够识别现有治疗记录中的因素 过度使用和滥用这些药物的风险最大的个人。这些发现将会有 对有不明病史的初级保健患者的管理有重要临床意义 酒精使用障碍和与医疗获取酒精治疗记录有关的政策影响。

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.